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  1. Long term complications of diabetes

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000327.htm Long term complications of diabetes To use the sharing ... sores and infections. If it goes on too long, your toes, foot, or leg may need to ...

  2. Long-Term Complications of Diabetes

    MedlinePlus

    ... vessel problems, as well as other diabetes complications. Gum Disease People with diabetes are more likely than others to develop gum disease (also called periodontal disease) because they may have: ...

  3. Long-term oral complications of allogeneic haematopoietic SCT.

    PubMed

    Hull, K M; Kerridge, I; Schifter, M

    2012-02-01

    This study assessed the incidence of long-term oral complications in 88 survivors of allogeneic haematopoietic cell transplantation (HCT). Patients examined were between 6 months and 6 years post-HCT and aged from 19 to 65 years. Subjects were investigated for both the subjective and objective features of long-term adverse oral effects of HCT. The most common oral symptoms reported were xerostomia (44%, n=39) and reduction in taste (20%, n=18). Only a minority of patients (15%) reported that oral disease had a significant adverse impact upon their quality of life. The majority of patients (53%) had clinical markers of oral chronic GVHD (cGVHD). The most frequently identified feature was salivary hypofunction, with 34% of subjects demonstrating a reduction in stimulated saliva. Oral mucosal changes consistent with cGVHD affected 21% of subjects. Oral cGVHD commonly occurs after allogeneic HCT, often coexists with cutaneous, hepatic or ocular cGVHD and may lead to debilitating symptoms. Transplant type and pre-existing acute GVHD are the major risk factors for oral cGVHD. The identification of risk factors specific for oral cGVHD may allow clinicians some foresight into identifying patients at high risk of developing oral cGVHD and encourage attention to education, regular oral surveillance and rigorous preventative oral health strategies both pre- and post-transplant. PMID:21441960

  4. Long-term complications associated with permanent dermal fillers.

    PubMed

    Kunjur, Jayanth; Witherow, Helen

    2013-12-01

    We report a case series of patients with serious long-term complications associated with the injection of permanent dermal fillers. Although such complications are relatively rare, the consequences are potentially life-long, and the psychological and medical effects can often have a profound impact on the patient. The continued routine offering of these treatments will require doctors to communicate effectively with patients about the nature of the complications and the probability of risk compared with alternative treatments. PMID:23962591

  5. Radiotherapy for pituitary adenomas: long-term outcome and complications

    PubMed Central

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung Ae

    2011-01-01

    Purpose To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. Materials and Methods We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Results Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia

  6. [Long-term evolution and complications of eating disorders].

    PubMed

    Nicolas, Isabelle

    2008-01-31

    Eating disorders long-term evolution is good in 50% of cases, middle in 25% (recovery from eating disorders, but still psychological suffering) and bad in 25% of cases, with chronic eating disorders, anxious or depressive comorbid disorder, and bad consequences in social patients' life. Anorexia nervosa has a considerably worse long-term outcome than bulimia nervosa or binge eating disorders. Never the less, purging bulimia nervosa is often associated with other impulsive symptoms, such as addictions and suicide attempts. Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis. These complications need a specific medical follow up, at least once a year, added to the psychiatric and psychotherapist follow-up. PMID:18361276

  7. Long term complications following 54 consecutive lung transplants

    PubMed Central

    Tabarelli, Walther; Bonatti, Hugo; Tabarelli, Dominique; Eller, Miriam; Müller, Ludwig; Ruttmann, Elfriede; Lass-Flörl, Cornelia; Larcher, Clara

    2016-01-01

    Background Due to the complex therapy and the required high level of immunosuppression, lung recipients are at high risk to develop many different long term complications. Methods From 1993–2000, a total of 54 lung transplantation (LuTx) were performed at our center. Complications, graft and patient survival of this cohort was retrospectively analyzed. Results One/five and ten-year patient survival was 71.4%, 41.2% and 25.4%; at last follow up (4/2010), twelve patients were alive. Of the 39 deceased patients, 26 died from infectious complications. Other causes of death were myocardial infarction (n=1), progressive graft failure (n=1), intracerebral bleeding (n=2), basilary vein thrombosis (n=1), pulmonary emboli (n=1), others (n=7). Surgical complication rate was 27.7% during the first year and 25% for the 12 long term survivors. Perioperative rejection rate was 35%, and 91.6% for the 12 patients currently alive. Infection incidence during first hospitalization was 79.6% (1.3 episodes per transplant) and 100% for long term survivors. Commonly isolated pathogens were cytomegalovirus (56.8%), Aspergillus (29.4%), RSV (13.7%). Other common complications were renal failure (56.8%), osteoporosis (54.9%), hypertension (45%), diabetes mellitus (19.6%). Conclusions Infection and rejection remain the most common complications following LuTx with many other events to be considered. PMID:27293842

  8. [ASSOCIATION BETWEEN PREGNANCY COMPLICATIONS AND LONG TERM MATERNAL CARDIOVASCULAR MORBIDITY].

    PubMed

    Kessous, Roy; Shoham-Vardi, Ilana; Parientel, Gali; Sheiner, Eyal

    2016-05-01

    In recent years there is a significant increase in the rate of the metabolic syndrome. Correspondingly, and possibly due to this increase, there is a significant increase in cardiovascular events in women. Contradictory to the concept that obstetric complication is limited to pregnancy, some obstetric complications may cause or seemingly provide a preliminary sign for future maternal morbidity. In recent years there have been an increasing number of studies that examined the theory that vascular-related complications of pregnancy may be associated with increased risk for future maternal cardiovascular morbidity. We present a review of the literature, in addition to a series of studies conducted in Soroka University Medical Center that examined the association between pregnancy complications such as preeclampsia, gestational diabetes mellitus, preterm delivery, placental abruption and recurrent pregnancy loss and future long term maternal cardiovascular morbidity. PMID:27526556

  9. Factors Affecting Long-Term Abstinence from Substances Use

    ERIC Educational Resources Information Center

    Elsheikh, Salah Elgaily

    2008-01-01

    Objective: The purpose of this study is to explore the attitudes of abstainers from drug use that relate to the factors leading to long-term abstinence. Materials and Methods: Cross-sectional study was carried out in Al-Amal Hospital to examine, which attitudes of abstainers related to long-term abstinence. A random survey was conducted on 62…

  10. Long-Term Complications of Diabetes (For Parents)

    MedlinePlus

    ... and health problems. previous continue Nerve Damage (Diabetic Neuropathy) Another complication that people who have had diabetes ... younger people with poor blood sugar control. Diagnosing Neuropathy Talk to your doctor if your child has ...

  11. Long-term natural history and complications of collagenous colitis

    PubMed Central

    Freeman, Hugh J

    2012-01-01

    Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Sometimes significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. However, rare fatalities have been reported and several complications, some severe, have been attributed directly to the colitis. Toxic colitis and toxic megacolon may develop. Concomitant gastric and small intestinal inflammatory disorders have been described including celiac disease and more extensive collagenous inflammatory disease. Colonic ulceration has been associated with the use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn disease, may evolve directly from collagenous colitis. Submucosal ‘dissection’, colonic fractures, or mucosal tears and perforation, possibly from air insufflation during colonoscopy, have been reported. Similar changes may result from increased intraluminal pressures that may occur during radiological imaging of the colon. Neoplastic disorders of the colon may also occur during the course of collagenous colitis, including colon carcinoma and neuroendocrine tumours (ie, carcinoids). Finally, lymphoproliferative disease has been reported. PMID:22993735

  12. Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique

    PubMed Central

    Andersen, Lars Peter Holst; Klein, Mads; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    Background Incisional hernia after abdominal surgery is a well-known complication. Controversy still exists with respect to the choice of hernia repair technique. The objective of this study was to evaluate the long-term recurrence rate as well as surgical complications in a consecutive group of patients undergoing open repair using an onlay mesh technique. Methods Consecutive patients undergoing open incisional hernia repair with onlay-technique between 01/05/1995 and 01/09/2007 at a single institution were included in the study. For follow-up patients were contacted by telephone, and answered a questionnaire containing questions related to the primary operation, the hernia and general risk factors. Patients were examined by a consultant surgeon in the outpatient clinic or in the patient's home if there was suspicion of an incisional hernia recurrence. Results The study included 56 patients with 100% follow-up. The median follow-up was 35 months (range 4–151). Recurrent incisional hernia was found in 8 of 56 patients (15%, 95% CI: 6–24). The overall complication rate was 13% (95% CI, 4–22). All complications were minor and needed no hospital admission. Conclusion This study with a long follow-up showed low recurrence and complication rates in patients undergoing incisional hernia repair with the open onlay technique. PMID:19400934

  13. [Management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors. Proposals of the Working Group on Perioperative Haemostasis (GIHP) - March 2013].

    PubMed

    Pernod, G; Albaladejo, P; Godier, A; Samama, C M; Susen, S; Gruel, Y; Blais, N; Fontana, P; Cohen, A; Llau, J V; Rosencher, N; Schved, J F; de Maistre, E; Samama, M M; Mismetti, P; Sié, P

    2013-10-01

    New direct oral anticoagulants (NOAC), inhibitors of factor IIa or Xa, are expected to be widely used for the treatment of venous thromboembolic disease, or in case of atrial fibrillation. Such anticoagulant treatments are known to be associated with haemorrhagic complications. Moreover, it is likely that such patients on long-term treatment with NOAC will be exposed to emergency surgery or invasive procedures. Due to the present lack of experience in such conditions, we cannot make recommendations, but only propose management for optimal safety as regards the risk of bleeding in such emergency conditions. In this article, only dabigatran and rivaroxaban were discussed. For emergency surgery at risk of bleeding, we propose to dose the plasmatic concentration of drug. Levels inferior or equal to 30ng/mL for both dabigatran and rivaroxaban, should enable the realization of a high bleeding risk surgery. For higher concentration, it was proposed to postpone surgery by monitoring the evolution of the drug concentration. Action is then defined by the kind of NOAC and its concentration. If the dosage of the drug is not immediately available, proposals only based on the usual tests, PT and aPTT, also are presented. However, these tests do not really assess drug concentration or bleeding risk. In case of severe haemorrhage in a critical organ, it is proposed to reduce the effect of anticoagulant therapy using a nonspecific procoagulant drug (activated prothrombin concentrate, FEIBA, 30-50U/kg, or non-activated 4-factors prothrombin concentrates 50U/kg). For any other type of severe haemorrhage, the administration of such a procoagulant drug, potentially thrombogenic in these patients, will be discussed regarding concentration of NACO and possibilities for mechanical haemostasis. PMID:23993157

  14. Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion

    SciTech Connect

    Ozkan, Ugur Oguzkurt, Levent; Tercan, Fahri

    2010-02-15

    The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis ({<=}30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a

  15. Eye complications and markers of morbidity and mortality in long-term type 1 diabetes.

    PubMed

    Grauslund, Jakob

    2011-02-01

    The incidence of type 1 diabetes is rising all over the world. Furthermore, the increased life-expectancy of type 1 diabetic patients is likely to cause a higher number of diabetes-related micro- and macrovascular complications in the years to come. In order to examine the level of long-term complications in type 1 diabetes as well as potential markers of micro- and macroangiopathy, a population-based cohort of Danish type 1 diabetic patients was examined in order to achieve the following aims: 1. To evaluate diabetic retinopathy as a long-term marker of all-cause mortality in type 1 diabetes (Paper I). 2. To estimate the long-term incidence and associated risk factors of blindness (Paper II) and cataract surgery (Paper III) in type 1 diabetes. 3 To use retinal vascular analyses in order to investigate the associations of long-term micro- and macrovascular complications and retinal vascular diameters (Paper IV) and retinal fractals (Paper V) in type 1 diabetes. 4. To examine N-terminal pro brain natriuretic peptide (Paper VI) and osteoprotegerin (Paper VII) as non-invasive markers of micro- and macrovascular complications in type 1 diabetes. In Paper I it was a major finding that, despite a mean age of only 38.3 years at baseline, 44.7% of the patients died during the 25-year follow-up. Patients who had proliferative retinopathy as well as proteinuria at the baseline examination had a significantly higher mortality. For these, the 10-year survival was only 22.2%. As demonstrated in Paper II, blindness is an important issue in type 1 diabetes. The 25-year cumulative incidence of blindness was 7.5%. Glycaemic regulation and maculopathy at baseline were both identified as risk factors of blindness. Finally, mortality was higher in patients who went blind during the follow-up. Cataract surgery is quite common in type 1 diabetes. In Paper III a 25-year cumulative incidence of 20.8% was found. Adjusted for mortality, this was even higher (29.4%). As compared to patients

  16. What Factors Influence Long-term Survivorship After Hip Arthroscopy?

    PubMed Central

    Jarrett, Bryan T.; Ojeifo, Olumide; Lee, Jo Ann; Bragdon, Charles R.

    2010-01-01

    Background Hip arthroscopy is an evolving procedure. One small study suggested that a low modified Harris hip score and arthritis at the time of surgery were predictors of poor prognosis. Questions/purposes We therefore intended to confirm those findings with a large patient cohort to (1) determine the long-term nonarthritic hip score; (2) determine survivorship; (3) identify risk factors that increase the likelihood of THA; and (4) use those factors to create a usable risk assessment algorithm. Patients and Methods We retrospectively reviewed 324 patients (340 hips) who underwent arthroscopy for pain and/or catching. Of these, 106 patients (111 hips or 33%) had a minimum followup of 10 years (mean, 13 years; range, 10–20 years). The average age was 39 years (± 13) with 47 men and 59 women. We recorded patient age, gender, acetabular and femoral Outerbridge grade at surgery, and the presence of a labral tear. Followup consisted of a nonarthritic hip score or the date of a subsequent THA. We determined survivorship with the end point of THA for the acetabular and femoral Outerbridge grades. Results Overall survivorship among the 111 hips was 63% at 10 years. The average nonarthritic hip score for non-THA patients was 87.3 (± 12.1). Survivorship was greater for acetabular and femoral Outerbridge grades normal through II. Age at arthroscopy and Outerbridge grades independently predicted eventual THA. Gender and the presence of a labral tear did not influence long-term survivorship. Conclusions The long-term survivorship of labral tears with low-grade cartilage damage indicates hip arthroscopy is reasonable for treating labral tears. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:20872105

  17. Fibroepithelial polyp of the prepuce: A rare complication of long-term condom catheter usage

    PubMed Central

    Banerji, John S.; Shah, Sanjeev; Kekre, Nitin S.

    2008-01-01

    External urinary drainage devices are in wide clinical uses. There are only a few reports of complications from improper use of condom catheters. We present a case of fibroepithelial polyp of the penis, due to long-term usage of condom catheter. The lesion affected the ventral aspect of the penis. He was successfully treated with wide local excision. The histopathological diagnosis was a fibroepithelial polyp. PMID:19468410

  18. Long-term complications after surgical correction of Laubry-Pezzi syndrome

    PubMed Central

    Sbizzera, Marc; Cosset, Benoit; Koffel, Catherine; Obadia, Jean François; Robin, Jacques

    2016-01-01

    Laubry-Pezzi syndrome is a rare congenital heart disease (CHD) combining a ventricular septal defect (VSD) and an aortic regurgitation (AR) due to a prolapse of the right coronary or, less frequently, non-coronary cusp. In the literature there are very few reports of long-term complications after surgical correction of this syndrome. We present the late occurrence of an aortic root pseudoaneurysm and a residual VSD in a patient with Laubry-Pezzi syndrome operated during childhood. PMID:27076977

  19. [Long-term complications of sulfur mustard exposure: a therapeutic update].

    PubMed

    Shiyovich, Arthur; Rosman, Yossi; Krivoy, Amir; Statlender, Liran; Kassirer, Michael; Shrot, Shai

    2014-01-01

    Sulfur mustard (SM) is an alkylating chemical warfare agent with high military significance due to its high toxicity, resistance and availability. SM was widely used in military conflicts, the last being the Iran-Iraq war with more than 100,000 Iranians exposed, one-third of whom are still suffering from late effects. The intensity of the delayed complications correlates to the extent, the area and the route of exposure. The clinical manifestations most commonly involve respiratory, ocular and dermal effects. Respiratory complications include dyspnea, cough and expectorations and various obstructive and restrictive lung diseases. Dermal complications are itching, burning sensation, blisters, dry skin, dermatitis and pigmentary changes. Ocular complications include photophobia, red eye, tearing, corneal ulcers and blindness. Although the picture remains incomplete the major mechanisms responsible for the clinical and pathological effects of SM are: DNA alkylation and cross-linking, protein modification and membrane damage in addition to induction of inflammatory mediators in the target tissues causing extensive necrosis, apoptosis and loss of tissue structure. The current report reviews long-term complications of SM exposure, focusing on new treatments tested in clinical trials conducted on humans. Such treatments include: N-acetyl cysteine, bronchodilators, corticosteroids, Interferon-gamma, furosemide and morphine for the respiratory complications. Ocular complications may entail: Invasive procedures treating corneal complication, limbal ischemia and stem cell deficiency. Treatment for dermatological complications include: anti-depressants, pimercrolimus, Unna's boot, capsaicin, phenol and menthol, Aloe vera and olive oil, curcumin and Interferon-gamma. PMID:24791566

  20. Nitric-Oxide Supplementation for Treatment of Long-Term Complications in Argininosuccinic Aciduria

    PubMed Central

    Nagamani, Sandesh C.S.; Campeau, Philippe M.; Shchelochkov, Oleg A.; Premkumar, Muralidhar H.; Guse, Kilian; Brunetti-Pierri, Nicola; Chen, Yuqing; Sun, Qin; Tang, Yaoping; Palmer, Donna; Reddy, Anilkumar K.; Li, Li; Slesnick, Timothy C.; Feig, Daniel I.; Caudle, Susan; Harrison, David; Salviati, Leonardo; Marini, Juan C.; Bryan, Nathan S.; Erez, Ayelet; Lee, Brendan

    2012-01-01

    Argininosuccinate lyase (ASL) is required for the synthesis and channeling of L-arginine to nitric oxide synthase (NOS) for nitric oxide (NO) production. Congenital ASL deficiency causes argininosuccinic aciduria (ASA), the second most common urea-cycle disorder, and leads to deficiency of both ureagenesis and NO production. Subjects with ASA have been reported to develop long-term complications such as hypertension and neurocognitive deficits despite early initiation of therapy and the absence of documented hyperammonemia. In order to distinguish the relative contributions of the hepatic urea-cycle defect from those of the NO deficiency to the phenotype, we performed liver-directed gene therapy in a mouse model of ASA. Whereas the gene therapy corrected the ureagenesis defect, the systemic hypertension in mice could be corrected by treatment with an exogenous NO source. In an ASA subject with severe hypertension refractory to antihypertensive medications, monotherapy with NO supplements resulted in the long-term control of hypertension and a decrease in cardiac hypertrophy. In addition, the NO therapy was associated with an improvement in some neuropsychological parameters pertaining to verbal memory and nonverbal problem solving. Our data show that ASA, in addition to being a classical urea-cycle disorder, is also a model of congenital human NO deficiency and that ASA subjects could potentially benefit from NO supplementation. Hence, NO supplementation should be investigated for the long-term treatment of this condition. PMID:22541557

  1. Vulvar Epidermal Inclusion Cyst as a Long-term Complication of Female Genital Mutilation.

    PubMed

    Victoria-Martínez, Ana Mercedes; Cubells-Sánchez, Laura; Martínez-Leborans, Lorena; Sánchez-Carazo, José Luis; de Miquel, Víctor Alegre

    2016-01-01

    We present a case report of a patient with epidermal inclusion cyst as a late complication of female genital mutilation (FGM). We describe the management of the patient, and a review of the literature. We report the clinical and pathological findings in a 37-year-old female patient from Nigeria, with a clitoral mass of 1 year duration. She declared to have an FGM since she was 5 years. The lesion was excised successfully with good cosmetic results. Histological examination revealed epidermal cyst with the presence of granular layer. An epidermal inclusion cyst can develop as a long-term consequence of FGM. PMID:26955127

  2. Vulvar Epidermal Inclusion Cyst as a Long-term Complication of Female Genital Mutilation

    PubMed Central

    Victoria-Martínez, Ana Mercedes; Cubells-Sánchez, Laura; Martínez-Leborans, Lorena; Sánchez-Carazo, José Luis; de Miquel, Víctor Alegre

    2016-01-01

    We present a case report of a patient with epidermal inclusion cyst as a late complication of female genital mutilation (FGM). We describe the management of the patient, and a review of the literature. We report the clinical and pathological findings in a 37-year-old female patient from Nigeria, with a clitoral mass of 1 year duration. She declared to have an FGM since she was 5 years. The lesion was excised successfully with good cosmetic results. Histological examination revealed epidermal cyst with the presence of granular layer. An epidermal inclusion cyst can develop as a long-term consequence of FGM. PMID:26955127

  3. Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

    SciTech Connect

    Lo, Andrea C.; Howard, A. Fuchsia; Nichol, Alan; Sidhu, Keerat; Abdulsatar, Farah; Hasan, Haroon; Goddard, Karen

    2014-04-01

    Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.

  4. Factors influencing oral health in long term care facilities.

    PubMed

    MacEntee, M I; Weiss, R; Waxler-Morrison, N E; Morrison, B J

    1987-12-01

    In a stratified random sample of 41 long term care (LTC) facilities in Vancouver, 653 residents were chosen to investigate oral health needs and demands for treatment. All of the 603 dentists in the same area were questioned to assess their interest in attending the residents of the institutions. The information from each source was reviewed to identify factors influencing the oral health services to this predominantly elderly and medically compromised population. The majority (60%) of the residents were edentulous and they made infrequent demands on dentists. Two-thirds of those interviewed said that there was nothing wrong with their mouths, but most of those who were aware of a problem wanted it treated, preferably within the institution. They complained about loose or uncomfortable dentures most frequently, and many were dissatisfied with previous dental treatment. The oral mucosal lesions seen on examination were usually symptomless and associated with poor hygiene, while structurally defective dentures and deep carious lesions were not uncommon. The responding 334 dentists indicated that they enjoyed treating elderly patients, 19% had attended an LTC facility, usually to provide an emergency service, and 37% were willing to provide this service if asked. Interest, however, in the service was curtailed by pressures from private practice, concerns about inadequate training and the small demand and poor conditions in the facilities. Although the demand for treatment was not extensive from the residents, they did have problems that were not receiving care. PMID:3121247

  5. Long-term results and complications of preoperative radiation in the treatment of rectal cancer

    SciTech Connect

    Reed, W.P.; Garb, J.L.; Park, W.C.; Stark, A.J.; Chabot, J.R.; Friedmann, P.

    1988-02-01

    A retrospective study of 149 patients with rectal cancer diagnosed between 1972 and 1979 was undertaken to compare survival, disease-free survival, recurrence sites, and long-term complications of 40 patients who received 4000 to 4500 rads of preoperative adjuvant radiotherapy (radiation group) with those of 109 patients treated by resection alone (control group). After a mean follow-up of 84 months and 99 months, respectively, survival of the irradiated patients was significantly better than that of controls (68% versus 52%, p less than 0.05). Disease-free survival of those patients rendered free of disease by treatment was also superior for the irradiated group (84% versus 57%, p less than 0.005). Local recurrence without signs of distant metastases developed only one-third as often in irradiated patients (6% versus 18%). Distant metastases, alone or in combination with local recurrence, were also less common after radiation (12% versus 27%). Second primary tumors developed in 15% and 10% of the respective groups, a difference that was not statistically significant. When we consider the survival benefit of preoperative radiation therapy, long-term complications were relatively mild. Delayed healing of the perineum was noted in two irradiated patients. Persistent diarrhea was severe enough to warrant treatment in only one case, and one patient required a colostomy for intestinal obstruction from pelvic fibrosis.

  6. Long-term infectious complications of using porous polyethylene mesh for orbital fracture reconstruction

    PubMed Central

    Song, Xuefei; Li, Lunhao; Sun, Yiyuan; Fan, Xianqun; Li, Zhengkang

    2016-01-01

    Abstract Porous polyethylene is a widely used implants in orbital reconstruction, on which comprehensive clinical analysis, various treatments, and different prognosis according to specific classification principles on long-term complications have not been reported. To investigate the new clinical symptoms, intraoperative findings, treatments, and outcomes of complications long period after previous surgery, resulting from the use of porous polyethylene mesh for orbital fracture reconstruction. A retrospective study was conducted on 21 patients at the Department of Ophthalmology, Shanghai Ninth People's Hospital with orbital complications after orbital fracture reconstruction with porous polyethylene mesh for 4 ± 2.2 years from 2011 to 2013. These data included new clinical symptoms after previous surgery, computerized tomography data, intraoperative findings, treatments, and outcomes. Data from 21 patients were analyzed in this study. Two patients received conservative treatment, while the other 19 patients underwent surgical approaches. Classification principles for orbital complications after orbital wall defect reconstruction with porous polyethylene mesh were formulated according to patients’ new clinical symptoms, computed tomography (CT), and intraoperative findings after previous surgery. In the last follow-up, 19 patients (90.5%) were cured or improved according to our assessment principle. The follow-up ranged from 3 to 45 months (35 months in average). According to specific classification for orbital complications resulting from the use of porous polyethylene mesh for orbital fracture reconstruction, various medical treatments should be carried out, and the prognosis may be different. PMID:27336867

  7. Long term cerebral and vascular complications after irradiation of the neck in head and neck cancer patients: a prospective cohort study: study rationale and protocol

    PubMed Central

    2014-01-01

    Background Successful treatment options for cancer result in more young long-term survivors prone for long-term complications. Carotid artery vasculopathy is a potential long-term complication after radiotherapy of the neck, resulting in cerebrovascular events and probably deficits in cognitive and motor functioning. Better insight into the underlying pathofysiology of radiotherapy induced carotid artery vasculopathy is needed for prognostic purposes and to develop preventive strategies. Methods/Design The current study is a prospective cohort study on the long-term cerebral and vascular complications after radiotherapy of the neck, in 103 patients treated for head and neck cancer, included in our study database between 2002 and 2008. Baseline protocol (before radiotherapy) included screening for cerebrovascular risk factors and intima media thickness measurement of carotid arteries by ultrasonography. Follow-up assessment more than 5 years after radiotherapy included screening of cerebrovascular risk factors, cerebrovascular events, neurological examination with gait and balance tests, extensive neuropsychological examination, self-report questionnaires, ultrasonography of the carotid arteries with measurement of intima media thickness and elastography, magnetic resonance imaging of the brain and magnetic resonance angiography of the carotid arteries. Discussion The current study adds to the understanding of the causes and consequences of long-term cerebral and vascular changes after radiotherapy of the neck. These data will be helpful to develop a protocol for diagnostic and preventive strategies for long-term neurological complications in future head and neck cancer patients with anticipated radiotherapy treatment. PMID:24942263

  8. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    PubMed Central

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover

  9. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery.

    PubMed

    Park, Jong Seob; Huh, Jung Wook; Park, Yoon Ah; Cho, Yong Beom; Yun, Seong Hyeon; Kim, Hee Cheol; Lee, Woo Yong

    2016-02-01

    Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes.We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data.Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively).AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery. PMID:26937928

  10. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery

    PubMed Central

    Park, Jong Seob; Huh, Jung Wook; Park, Yoon Ah; Cho, Yong Beom; Yun, Seong Hyeon; Kim, Hee Cheol; Lee, Woo Yong

    2016-01-01

    Abstract Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes. We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data. Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively). AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery. PMID:26937928

  11. Unusual long-term complication of polyalkylimide hydrogel manifesting as nasal septal abscess.

    PubMed

    Chang, Chul; Lee, Sun Bin

    2015-05-01

    Bio-Alcamid is a new synthetic polyacrylic hydrogel that contains alkylimide-amide groups and pyrogen-free water (96%) and has gained widespread use in cosmetic and reconstructive practice since being awarded a Conformite European certificate in 2001. According to the research on the efficacy and safety of the long-acting filler Bio-Alcamid in the early phases of development, Bio-Alcamid is nearly nontoxic and nonallergenic and has long in vivo persistence. It has been widely used because of its superior durability compared with short-acting fillers. Many published studies have examined only early-phase postoperative inflammatory responses. More recently, however, complications with delayed onsets ranging from several months to several years, such as inflammation and filler migration, have been emerging. Given the rapidly increasing application of long-term fillers, an increased incidence of complications is expected, and increasing awareness of its correct use and complication treatments is needed. To address this problem, we reviewed the safety of long-acting fillers on the basis of a rare case of surgical incision and drainage of a nasal septal abscess that developed in a patient 2 years after Bio-Alcamid was injected into the nasal region. PMID:25974816

  12. Heavy silicone oil as a long-term endotamponade agent for complicated retinal detachments.

    PubMed

    Prazeres, Juliana; Magalhães, Octaviano; Lucatto, Luiz F A; Navarro, Rodrigo Milan; Moraes, Nilva S; Farah, Michel E; Maia, André; Maia, Maurício

    2014-01-01

    We retrospectively evaluated a heavy silicone oil (HSO) as a long-term intraocular endotamponade agent to treat complicated RD by inferior PVR in 25 eyes of 25 patients. Patients underwent PPV and injection of Oxane HD as an internal tamponade agent. A comparison of preoperative and postoperative BCVA at month 1, month 6, and last visit was made in the group in which HSO was removed and in the group in which HSO was not removed. Statistical calculations were performed using the Wilcoxon test. The HSO was removed from 11 patients after a mean of 26.55 ± 21.38 months. The HSO remained inside the vitreous cavity in 14 eyes due to a high chance of PVR recurrence (mean follow-up period, 11.07 ± 7.44 months). Anatomic success was achieved in 92%. The BCVA in the group, in which HSO was not removed, improved significantly during the first 6 months. Among the patients who had the oil removed, there was improvement in BCVA after 1 month. Oil emulsification was the most common adverse effect in 52% of eyes. HSO is an effective tamponade in complex rhegmatogenous and tractional RD complicated by PVR. HSO can remain in the eye for long periods with relative tolerability and safety. PMID:24822176

  13. Detect Long-term Complications After ICD Replacement (DECODE): Rationale and Study Design of a Multicenter Italian Registry.

    PubMed

    Diemberger, Igor; Parisi, Quintino; De Filippo, Paolo; Narducci, Maria Lucia; Zanon, Francesco; Potenza, Domenico Rosario; Ciaramitaro, Gianfranco; Malacrida, Maurizio; Boriani, Giuseppe; Biffi, Mauro

    2015-10-01

    The replacement of implantable cardioverter-defibrillators (ICDs) may give rise to considerable clinical consequences, the importance of which is underrated by the medical community. Replacement-related adverse events are difficult to identify and require monitoring of both short-term complications and long-term patient outcome. The aim of this study is to perform a structured evaluation of both short- and long-term adverse events and a cost analysis of consecutive ICD replacement procedures. Detect Long-term Complications After ICD Replacement (DECODE) is a prospective, single-arm, multicenter cohort study designed to estimate long-term complication rates (at 12 months and 5 years) in patients undergoing ICD generator replacement. The study will also evaluate predictors of complications, patient management before and during the replacement procedure in clinical practice, and the costs related to use of health care resources. About 800 consecutive patients with standard indications for ICD generator replacement will be enrolled in this study. The decision to undertake generator replacement/upgrade will be made according to the investigators' own judgment (which will be recorded). Patients will be followed for 60 months through periodic in-hospital examinations or remote monitoring. Detailed data on complications related to ICD replacement in current clinical practice are still lacking. The analysis of adverse events will reveal the value of new preventive strategies, thereby yielding both clinical and economic benefits. Moreover, assessment of complication rates after ICD replacement in a real-life setting will help estimate the actual long-term cost of ICD therapy and assess the real impact of increasing ICD longevity on cost-effectiveness. PMID:26282191

  14. Uncertainty of the long-term resuspension factor

    NASA Astrophysics Data System (ADS)

    Garger, Evgenii K.; Hoffman, F. Owen; Thiessen, Kathleen M.

    Resuspension of contaminated soil into the atmosphere is one of the key processes that must be considered in the estimation of inhalation doses to humans. Data for air and soil contamination collected in Ukraine over several years since the Chernobyl accident have permitted analysis of resuspension in terms of the underlying mechanisms. Various empirical models for the resuspension factor as a function of time (e.g. Linsley, Garland, Anspaugh, etc.) are compared to the observed resuspension factors over time (9 yr) at two sites; in general, these models give overestimates for the resuspension factor as a function of time. The observed values of the resuspension factor range from greater than 10 -5 m -1 at early time points to around 10 -10 m -1 at later points. The uncertainty in the resuspension factor is decreased to within 1 order of magnitude if annual averaging of the experimental data is used and if the resuspension factor is determined as a function of time and of the predominant regional conditions of vegetative cover and climate.

  15. Factors Associated with the Effectiveness of Continuing Education in Long-Term Care

    ERIC Educational Resources Information Center

    Stolee, Paul; Esbaugh, Jacquelin; Aylward, Sandra; Cathers, Tamzin; Harvey, David P.; Hillier, Loretta M.; Keat, Nancy; Feightner, John W.

    2005-01-01

    Purpose: This article examines factors within the long-term-care work environment that impact the effectiveness of continuing education. Design & Methods: In Study 1, focus group interviews were conducted with staff and management from urban and rural long-term-care facilities in southwestern Ontario to identify their perceptions of the workplace…

  16. Long-term Effects of Topsoil Removal on Soil Productivity Factors, Wheat Yield and Protein Content

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Quantifying long term effects of soil erosion on plant production and soil quality factors can aid in restoring degraded soils to production. The objectives of this study were to determine the long-term effects of topsoil removal (artificial erosion) on spring wheat (Triticum aestivum L.) yield, gra...

  17. Studies on canine bone marrow long-term culture: effect of stem cell factor.

    PubMed

    Neuner, E; Schumm, M; Schneider, E M; Guenther, W; Kremmer, E; Vogl, C; Büttner, M; Thierfelder, S; Kolb, H J

    1998-02-16

    Long-term culture of canine marrow cells allows in vitro studies of the hematopoietic system of the dog and characterization of early progenitor cells. Colonies of fresh marrow cells grew equally good in both agar or methylcellulose supplemented with fetal calf serum, while colonies of long-term cultures required agar-based medium containing human serum. Optimum colony growth was obtained when stem cell factor (SCF) and granulocyte-macrophage-colony-stimulating factor (GM-CSF) were used as growth stimuli of colony forming units (CFU). Similar results were achieved with several cell culture media. Addition of hydrocortisone to long-term cultures improved clonogenic growth of cultured cells. Addition of 2-mercaptoethanol had no effect. Strong differences were observed in long-term culture with different horse serum lots and the addition of fetal calf serum to long-term culture suppressed CFU growth of cultured cells. Recharging of cultures with fresh marrow cells on day 7 of culture improved CFU growth only in the following week but had little effect on the outcome. Adding SCF to long-term cultures led to differentiation of more primitive cells and destruction of the stromal layer. Investigation of purified and cultured cell populations was possible when preestablished long-term cultures as stromal layers were used. Loss of long-term culture-initiating ability could be demonstrated in this system with lineage negative marrow cells expanded ex vivo with SCF and GM-CSF. PMID:9613468

  18. Management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors: proposals of the working group on perioperative haemostasis (GIHP) - March 2013.

    PubMed

    Pernod, Gilles; Albaladejo, Pierre; Godier, Anne; Samama, Charles M; Susen, Sophie; Gruel, Yves; Blais, Normand; Fontana, Pierre; Cohen, Ariel; Llau, Juan V; Rosencher, Nadia; Schved, Jean-François; de Maistre, Emmanuel; Samama, Meyer M; Mismetti, Patrick; Sié, Pierre

    2013-01-01

    Direct new oral anticoagulants (NOACs) - inhibitors of thrombin or factor Xa - are intended to be used largely in the treatment of venous thromboembolic disease or the prevention of systematic embolism in atrial fibrillation, instead of vitamin K antagonists. Like any anticoagulant treatment, they are associated with spontaneous or provoked haemorrhagic risk. Furthermore, a significant proportion of treated patients are likely to be exposed to emergency surgery or invasive procedures. Given the absence of a specific antidote, the action to be taken in these situations must be defined. The lack of data means that it is only possible to issue proposals rather than recommendations, which will evolve according to accumulated experience. The proposals presented here apply to dabigatran (Pradaxa(®)) and rivaroxaban (Xarelto(®)); data for apixaban and edoxaban are still scarce. For urgent surgery with haemorrhagic risk, the drug plasma concentration should be less or equal to 30ng/mL for dabigatran and rivaroxaban should enable surgery associated with a high bleeding risk. Beyond that, if possible, the intervention should be postponed by monitoring the drug concentration. The course to follow is then defined according to the NOAC and its concentration. If the anticoagulant dosage is not immediately available, worse propositions, based on the usual tests (prothrombin time and activated partial thromboplastin time), are presented. However, these tests do not really assess drug concentration or the risk of bleeding that depends on it. In case of serious bleeding in a critical organ, the effect of anticoagulant therapy should be reduced using a non-specific procoagulant drug as a first-line approach: activated prothrombin complex concentrate (aPCC) (FEIBA(®) 30-50U/kg) or non-activated PCC (50U/kg). In addition, for any other type of severe haemorrhage, the administration of a procoagulant drug, which is potentially thrombogenic in these patients, is discussed according

  19. [Long-term prognostic factors in Parkinson's disease (author's transl)].

    PubMed

    Guillard, A; Chastang, C

    1978-05-01

    Acturial methods are used to study the correlation between the initial condition and early therapeutic results, and the present condition of 164 parkinsonian patients treated with L. dopa for 4 to 8 years. There is an ineluctable deterioration in motility. There is a lower risk in patients who are autonomous and only slightly akinetic at the beginning of treatment. Intellectual deterioration is seen in some patients only. The risk factors are: males, the clinical forms of Parkinson's disease in which tremor is not predominant, onset of the disease before 60 years of age, and depression and transitory psychotic disorders during the first year of treatment. This deterioration appears 3 to 5 years after starting dopatherapy, which could be the cause. Life expectancy is still reduced by the disease at the present time. It is longer in patients in whom the disease started with isolated tremors, absence of Babinski's sign, and no loss of autonomy, and those in whom a good initial therapeutic result was obtained. PMID:725403

  20. Internal jugular vein thrombosis presenting as a painful neck mass due to a spontaneous dislocated subclavian port catheter as long-term complication: a case report.

    PubMed

    Binnebösel, Marcel; Grommes, Jochen; Junge, Karsten; Göbner, Sonja; Schumpelick, Volker; Truong, Son

    2009-01-01

    Central venous access devices are extensively used for long-term chemotherapy and parenteral nutrition. However, there are some possible immediate, early, and late complications related to the implantation technique, care, and maintenance. We present the uncommon occurrence of a thrombosis of the internal jugular vein due to a spontaneous migration of a Port-A-Cath catheter into the ipsilateral internal jugular vein as a delayed complication of a central venous access catheter implanted for chemotherapy delivery. A review of the literature is given, and the factors responsible for this unusual complication will be discussed. PMID:19830037

  1. Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis

    PubMed Central

    Zhu, Y.; Wang, B.; Meng, Q.; Liu, J.; Zhai, S.; He, J.

    2016-01-01

    This study aimed to evaluate the long-term survival and risk factors of traditional open surgical repair (OSR) vs thoracic endovascular aneurysm repair (TEVAR) for complicated type-B aortic dissection (TBAD). A total of 118 inpatients (45 OSR vs 73 TEVAR) with TBAD were enrolled from January 2004 to January 2015. Kaplan-Meier curves and Cox proportional hazards analysis were performed to identify the long-term survival rate and independent predictors of survival, respectively. Meta-analysis was used to further explore the long-term efficacy of OSR and TEVAR in the eight included studies using Review Manager 5.2 software. An overall 10-year survival rate of 41.9% was found, and it was similar in the two groups (56.7% OSR vs 26.1% TEVAR; log-rank P=0.953). The risk factors of long-term survival were refractory hypertension (OR=11.1; 95%CI=1.428-86.372; P=0.021] and preoperative aortic diameter >55 mm (OR=4.5; 95%CI=1.842-11.346; P=0.001). Long-term survival rate did not differ significantly between OSR and TEVAR (hazard ratio=0.87; 95%CI=0.52-1.47; P=0.61). Compared with OSR, TEVAR did not show long-term advantages for patients with TBAD. Refractory hypertension and total aortic diameter >55 mm can be used to predict the long-term survival of TBAD in the Chinese Han population. PMID:27254661

  2. Tenon's Cyst Presenting as a Long-Term Complication following Incision Cataract Surgery

    PubMed Central

    Krishnacharya, Prabhakar Srinivasapuram

    2013-01-01

    Context. Tenon's cyst or conjunctival cyst formation is not uncommon late complication of traditional extracapsular cataract surgery; however, few reports are available in the literature. Aims. Large cystic swellings were clinically diagnosed as filtering blebs at the cataract incision site in two patients. The purpose of the case presentation is to discuss the factors leading to cyst formation, visual loss and cyst recurrence after its excision. Patients and Methods. Case 1. Sixty-one-year-old male patient presented with a bleb at superior limbal region in the right eye, two years after cataract surgery. Case 2. A giant bleb was found at the same region in the right eye of a 65-year-old male patient, eight years after cataract surgery. Results. Complete excision of the cyst was performed with conjunctival autograft in the first patient and followed up for two years. No recurrence of the cyst was observed. Internal wound gaping was seen on gonioscopy in the second patient. Conclusions. Unstable scleral tunnel could explain bleb formation in both the patients. Complete bleb excision with conjunctival auto-graft resulted in closure of the defect with no bleb recurrence during two-year follow-up. Over-filtration causing hypotonic maculopathy was the reason for decreased vision in the second case. PMID:24348577

  3. Beta 2-microglobulin associated amyloidosis: a vanishing complication of long-term hemodialysis?

    PubMed

    Schwalbe, S; Holzhauer, M; Schaeffer, J; Galanski, M; Koch, K M; Floege, J

    1997-10-01

    Beta 2-microglobulin associated amyloidosis (A beta 2m amyloidosis) is considered an inevitable complication of chronic hemodialysis, particularly in hemodialysis with cellulose based membranes. We performed a single center study to assess the prevalence of A beta 2m amyloidosis in 1988 versus 1996. Randomly selected patients, studied in 1988, were matched for time on hemodialysis (mean 71 months, range 3 to 207) and age (mean 51 years, range 22 to 80) with patients of the 1996 population. Compared to 1988 patients, the 1996 patients exhibited a lower prevalence of carpal tunnel syndrome (7 of 43 in 1988 vs. 1 of 43 in 1996; P < 0.001) and radiological evidence of A beta 2m amyloidosis (13 of 34 patients vs. 3 of 34 patients positive; P < 0.001; and 33 of 272 possible sites affected in 1988 vs. 7 of 272 sites in 1996 patients; P < 0.05). Compared to the 1988 population, the 1996 population exhibited significantly lower serum aluminum levels, lower average serum creatinine (but not urea) levels, more frequent therapy with erythropoietin, less home hemodialysis, longer hemodialysis time using high-flux synthetic dialysis membranes (mean of 13% vs. 6% of the total hemodialysis time in the 1988 group), and more frequent usage of reverse osmosis water plus bicarbonate buffer for dialysate preparation. We conclude that the prevalence and severity of A beta 2m amyloidosis unexpectedly decreased by about 80% in our center between 1988 and 1996. Given the relatively short times spent on high flux hemodialysis in both groups, increased beta 2-microglobulin removal is unlikely to account for this phenomenon. Rather, other factors, for example, dialysate composition and purity, may be involved. PMID:9328948

  4. Comparison of Long-term Complications in Patients on Haemodialysis and Peritoneal Dialysis Longer than 10 Years

    PubMed Central

    Kayalar, Arzu Ozdemir; Koc, Yener; Yilmaz, Figen; Caglayan, Feyza Bayraktar; Sakaci, Tamer; Ahbap, Elbis; Ünsal, Abdulkadir

    2016-01-01

    Introduction Depending on developments in dialysis techniques and new treatment strategies for comorbid diseases, life expectancy has increased. As a result, dialysis related long term complications could be seen more frequently. We investigated and compared long term complications of the Haemodialysis (HD) and Peritoneal Dialysis (PD) in patients with history if either mode at least 10years. Materials and Methods A 13HD & 16PD patients were included to the study. Basic demographic parameters and prevalence of cardiovascular diseases (CVD), uraemic peripheral neuropathy (PNP), parathyroid adenoma, parathyroidectomy and acquired cystic disease (ACD) were assessed. Results HD patients were older than PD patients (p=0.035) and duration of dialysis was longer in HD patients (p=0.001). CVD was present in 18 patients (9 HD, 9 PD). There was no difference in presence of CVD between HD and PD patients (p=0.455). Valvular diseases (n=15), diastolic dysfunction (n=8), left ventricular hypertrophy (n=5), ischemic heart disease (n=3) and congestive heart failure (n=1) were investigated. Uraemic peripheral neuropathy was observed in 14 of the patients (8 HD, 6 PD patients). Eight patients had mixed type sensory motor neuropathy and 3 patients had mixed type sensorial neuropathy, 2 patients had demyelinating PNP, 1 patient had axonal PNP and 3 of them had CTS related to peripheral neuropathy. Parathyroid adenoma was detected in 4 patients (2 HD, 2 PD) and 3 patients (1 HD, 2 PD) had history of parathyroidectomy. Serum phosphate and iPTH levels were higher in HD patients (p=0.003, p=0.04, respectively). ACD was detected in 14 patients (7 HD, 7 PD). There was no difference between PD and HD patients (p=0.75). Conclusion HD patients were older than PD patients and had longer duration of dialysis. The prevalence of long term complications was similar in HD and PD modalities. CVD especially valvular diseases were common complication in both modalities PMID:27042493

  5. LONG-TERM STABILITY OF FOOD PATTERNS IDENTIFIED BY USE OF FACTOR ANALYSIS AMONG SWEDISH WOMEN

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Limited data exist on the reproducibility of food patterns measured using factor analysis, as well as the stability of patterns over time. Our primary objective was to explore the long-term stability of food patterns derived using confirmatory factor analysis among 33,840 women participating in the...

  6. Long-term results and complications after treatment of bilateral fractures of the mandibular condyle.

    PubMed

    Forouzanfar, Tymour; Lobbezoo, Frank; Overgaauw, Maarten; de Groot, Annemijn; Kommers, Sofie; van Selms, Maurits; van den Bergh, Bart

    2013-10-01

    The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n=42, 59%) and falls (n=20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3-193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p=0.02). Increasing age was significantly related to reduction in the intensity of pain (p=0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures. PMID:23375048

  7. Long Term Clinical and Visual Outcomes of Retrofixated Iris Claw Lenses Implantation in Complicated Cases

    PubMed Central

    Ganesh, Sri; Brar, Sheetal; Relekar, Kirti

    2016-01-01

    Aims: To evaluate the visual outcomes and complications after implantation of retrofixated iris claw (RFIC) lens in various challenging situations. Settings and Design: Retrospective, single centre, 8 year clinical audit. Materials and Methods: A retrospective analysis of cases who underwent RFIC lens implantation alone (group 1) or in combination with vitreoretinal (VR), corneal or glaucoma procedures (group 2) was performed. The main outcomes evaluated were corrected distant visual acuity (CDVA) and postoperative complications. The mean follow up was 13.09±6.8 (range 6-24) months. Results: The study involved 100 eyes of 83 patients with mean age of 51.1±25.4 years. Group 1 included 59 eyes and group 2 had 41 eyes. In group 1, the mean CDVA improved from 0.86±0.81 to 0.38±0.51 LogMAR (p<0.001) with 72.8% eyes having gain in lines (≥ 2 lines) of CDVA with safety index of 1.73. The mean CDVA in group 2 improved from 0.71±0.65 to 0.38±0.34 LogMAR (p=0.003) with 65.8% eyes having gain in lines (≥ 2 lines) of CDVA with a safety index of 1.54. Group 2 showed a higher complication rate of 36.59% compared to group 1 (20.34%). Significant complications noted were secondary glaucoma (8%), disenclavation of haptic (4%), subluxation of RFIC lens (1%). Conclusion: The visual outcome with RFIC lenses when combined with other intraocular procedures is mainly affected by the complexity of co-existing pathologies .The complications are more related to the combined procedures performed rather than RFIC lens implantation alone. This may still be acceptable when complication profile of other intraocular lenses is evaluated in similar challenging situations. PMID:27347246

  8. [A case of anorexia nervosa with severe physical complications resulting in long-term hospitalization].

    PubMed

    Saito, Shinnosuke; Sato, Mamoru; Kobayashi, Toshiyuki; Kato, Satoshi

    2013-01-01

    We report the case of a woman in her late twenties with anorexia nervosa who was difficult to treat both psychologically and physically because she resisted being treated despite presenting with various and severe physical complications, such as a refractory tracheoesophageal fistula. On admission, she weighed 24.8 kg and her body mass index was 9.6 kg/m2. Treatment on a medical ward was not possible due to her resistance to being fed and repeated secretive and deviant behaviors. Therefore, she was treated mainly on a psychiatric ward, with a psychiatrist as the attending doctor. After hospitalization for more than 3 years, she had sufficiently recovered to leave the hospital. She was discharged weighing 37.7 kg and her body mass index was 14.5 kg/m2. As physical complications, the patient manifested with a tracheoesophageal fistula, duodenal bulb perforation, and tension pneumothorax, which were considered to reflect the vulnerability of the intrapleural and intraperitoneal soft tissue. She also manifested with lower limb edema, pulmonary edema, pleural effusion, overreaction to a diuretic, dehydration, and hypernatremia, which were considered to reflect the disturbances of water balance. As seen in this case, a patient with anorexia nervosa who resists being fed, even though treatment of the physical complications requires an improved nutritional status above all, may require treatment on a psychiatric ward even at the risk of providing less than ideal care for the physical complications. We discuss "medical psychiatry" as a model for treating anorexia nervosa patients with severe physical complications. In this concept of "medical psychiatry", it is the most important that staff on the psychiatric ward take an interest in and have concerns about the patient's physical complications. If the psychiatrist as the attending doctor actively and continuously participates in the treatment of physical complications, it should be possible to create a treatment plan that

  9. Commercial kidney transplantation is an important risk factor in long-term kidney allograft survival.

    PubMed

    Prasad, G V Ramesh; Ananth, Sailesh; Palepu, Sneha; Huang, Michael; Nash, Michelle M; Zaltzman, Jeffrey S

    2016-05-01

    Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization. PMID:27083285

  10. Long-Term Results and Prognostic Factors of Fractionated Strontium-90 Eye Applicator for Pterygium

    SciTech Connect

    Arruda Viani, Gustavo Stefano, Eduardo Jose; Fendi, Ligia Issa de; Carrara Fonseca, Ellen

    2008-11-15

    Purpose: To evaluate the long-term safety, effectiveness, and prognostic factors of fractionated postoperative {beta}-irradiation. Methods and Materials: Between 1993 and 2005, 623 patients with 737 pterygium lesions were treated with a strontium-90 eye applicator after surgical excision. The median follow-up period was 60 months (range, 6.7-139.5). Of the 737 lesions, 644 were primary and 93 were recurrences after surgical removal alone. Fractionated radiotherapy (RT) to a total dose of 35 Gy in five to seven fractions was used. Results: A total of 73 local pterygium recurrences (9.9%) were noted. Of the recurrent cases, 80% were noted within 3 years after treatment. The 5- and 10-year probability of local control was 90% and 88%, respectively. The multivariate analysis for all cases demonstrated that gender, age, total radiation dose, recurrent pterygia, and interval between surgery and RT affected the overall local control rate. Late toxicities that might have been associated with strontium-90 RT included scleromalacia (scleral thinning) in nine eyes, adhesion of the eyelids in eight, cataracts in six, and scleral ulcer in five eyes. Conclusion: Fractionated strontium-90 RT to a total dose of approximately 35 Gy in five to seven fractions results in a similar local control rate as higher doses in other series, with an acceptable complication rate.

  11. Phytobezoar by aloe vera as long term complication after oesophagectomy resolved using cellulase

    PubMed Central

    Pinos, Nathalie; Moreno-Merino, Sergio; Congregado, Miguel

    2015-01-01

    Bezoars are uncommon diseases caused by the presence of indigestible mass of strange material in the gastrointestinal tract. Gold-standard treatment remains unclear and there are not clinical guidelines to follow. We present a very rare case of 53-year-old man suffering phytobezoar in a gastroplasty after oesophagectomy due to aloe vera ingestion as natural medicine. Finally it was solved with cellulase. Therefore, this is a scarcely complication after esophagectomy. Cellulase is a very good option to treat phytobezoar avoiding reintervention in this kind of patient. PMID:26094056

  12. Intestinal perforation as a long-term complication of plug and mesh inguinal hernioplasty: case report.

    PubMed

    Benedetti, M; Albertario, S; Niebel, T; Bianchi, C; Tinozzi, F P; Moglia, P; Arcidiaco, M; Tinozzi, S

    2005-03-01

    Tension-free and sutureless hernioplasty by plug and mesh of nonreabsorbable material is one of the most common techniques for inguinal hernia repair. It's a simple and quick procedure with a low cost and allows for a short hospital stay. It shows a low reoccurrence rate, but it can result, in very few cases, in complications strictly related to prosthetic material. The literature describes some cases of plug migration from its proper position, for example, to the scrotum, preperitoneal adipose tissue, and abdominal cavity. We report on a case of sigmoid colon perforation due to a plug of Trabucco hernioplasty performed 2 years previously. PMID:15290610

  13. State Long Term Care Ombudsman Programs: Factors Associated with Perceived Effectiveness

    ERIC Educational Resources Information Center

    Estes, Carroll L.; Zulman, Donna M.; Goldberg, Sheryl C.; Ogawa, Dawn D.

    2004-01-01

    Purpose: This article reports findings from a nationwide study on factors associated with the perceived effectiveness of state Long Term Care Ombudsman Programs (LTCOPs). Design and Methods: Researchers conducted telephone interviews with ombudsmen from the 50 state programs as well as from Washington, DC, and Puerto Rico. Data from the National…

  14. Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

    ERIC Educational Resources Information Center

    Lambert, Heather C.; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E. D.

    2005-01-01

    Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a…

  15. [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].

    PubMed

    Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent

    2013-01-01

    Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163

  16. Diagnosis and surgical treatment of isolated rectal endometriosis: long term complication of incomplete treatment for pelvic endometriosis.

    PubMed

    Kwack, Jae-Young; You, Seul Ki; Kwon, Yong-Soon

    2016-01-01

    A 40-year-old woman visited our hospital with cyclic hematochezia for four months. The patient had the history of laparoscopic-assisted vaginal hysterectomy because of severe dysmenorrhea two years ago at another tertiary hospital. According to the medical records, the past surgical treatment was incomplete excision of pelvic endometriotic lesions, especially in rectal serosal lesions. A colonoscopy and abdominopelvic computed tomography showed an isolated tumor mimicking neoplasm, in which a biopsy under colonoscopy was performed and the lesion was endometriosis pathologically. Laparoscopic anterior resection (LAR) was performed. There were no complications during intraoperative and postoperative period and the patient was discharged 7 days after the LAR. It is important for reducing of long-term complication like rectal endometriosis that complete and safe excision of pelvic endometriosis with expert surgical strategy. PMID:27375735

  17. Diagnosis and surgical treatment of isolated rectal endometriosis: long term complication of incomplete treatment for pelvic endometriosis

    PubMed Central

    Kwack, Jae-Young; You, Seul Ki; Kwon, Yong-Soon

    2016-01-01

    A 40-year-old woman visited our hospital with cyclic hematochezia for four months. The patient had the history of laparoscopic-assisted vaginal hysterectomy because of severe dysmenorrhea two years ago at another tertiary hospital. According to the medical records, the past surgical treatment was incomplete excision of pelvic endometriotic lesions, especially in rectal serosal lesions. A colonoscopy and abdominopelvic computed tomography showed an isolated tumor mimicking neoplasm, in which a biopsy under colonoscopy was performed and the lesion was endometriosis pathologically. Laparoscopic anterior resection (LAR) was performed. There were no complications during intraoperative and postoperative period and the patient was discharged 7 days after the LAR. It is important for reducing of long-term complication like rectal endometriosis that complete and safe excision of pelvic endometriosis with expert surgical strategy. PMID:27375735

  18. Long-Term Outcomes and Complications of Trabeculectomy for Secondary Glaucoma in Patients with Familial Amyloidotic Polyneuropathy

    PubMed Central

    Kawaji, Takahiro; Inoue, Toshihiro; Hara, Ryuhei; Eiki, Daisuke; Ando, Yukio; Tanihara, Hidenobu

    2014-01-01

    Objective Secondary glaucoma is a serious complication in patients with transthyretin (TTR)-related familial amyloidotic polyneuropathy (FAP). We assessed the long-term outcomes and complications of trabeculectomy with mitomycin C (MMC) for secondary glaucoma associated with FAP. Methods Medical case records of Kumamoto University Hospital were retrospectively reviewed. Twenty-one eyes of 13 patients (10 with FAP ATTR Val30Met; 3 with FAP ATTR Tyr114Cys) underwent trabeculectomy with MMC and follow-up of at least 2 years. The primary outcome measure was Kaplan-Meier survival, with failure of this treatment being defined as an intraocular pressure (IOP) of ≤5 mm Hg or ≥22 mm Hg on two consecutive visits or as additional operations needed to reduce IOP. Secondary outcome measures included complications, bleb characteristics, and additional postoperative interventions required. Results The mean postoperative follow-up period was 5.7 years (range, 2.2–12.7 years). Kaplan-Meier analysis indicated probabilities of success of 0.76, 0.67, and 0.53 at 1, 2, and 3 years after operation, respectively. Significant complications included ocular decompression retinopathy in 7 eyes (33%) and bleb encapsulation in 10 eyes (48%). Twelve eyes (57%) needed additional surgery, such as bleb revision or trabeculectomy with MMC, to reduce IOP. Conclusions Trabeculectomy with MMC may not be optimal for patients with FAP-related glaucoma and may have several significant complications. PMID:24802803

  19. Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn

    PubMed Central

    Kaplan, Adriana; Forbes, Mary; Bonhoure, Isabelle; Utzet, Mireia; Martín, Miguel; Manneh, Malick; Ceesay, Haruna

    2013-01-01

    Background Female genital mutilation/cutting (FGM/C) is a harmful traditional practice deeply rooted in 28 Sub-Saharan African countries. Its prevalence in The Gambia is 76.3%. The objective of this study was to gain precise information on the long-term health consequences of FGM/C in The Gambia as well as on its impact on delivery and on the health of the newborns. Methods Data were collected from 588 female patients examined for antenatal care or delivery in hospitals and health centers of the Western Health Region, The Gambia. The information collected, both through a questionnaire and medical examination, included sociodemographic factors, the presence or not of FGM/C, the types of FGM/C practiced, the long-term health consequences of FGM/C, complications during delivery and for the newborn. Odds ratios, their 95% confidence intervals, and P values were calculated. Results The prevalence of patients who had undergone FGM/C was 75.6% (type I: 75.6%; type II: 24.4%). Women with type I and II FGM/C had a significantly higher prevalence of long-term health problems (eg, dysmenorrhea, vulvar or vaginal pain), problems related to anomalous healing (eg, fibrosis, keloid, synechia), and sexual dysfunction. Women with FGM/C were also much more likely to suffer complications during delivery (perineal tear, obstructed labor, episiotomy, cesarean, stillbirth) and complications associated with anomalous healing after FGM/C. Similarly, newborns were found to be more likely to suffer complications such as fetal distress and caput of the fetal head. Conclusion This study shows that FGM/C is associated with a variety of long-term health consequences, that women with FGM/C are four times more likely to suffer complications during delivery, and the newborn is four times more likely to have health complications if the parturient has undergone FGM/C. These results highlight for the first time the magnitude of consequences during delivery and for the newborn, associated with FGM

  20. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort.

    PubMed

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-03-01

    Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia

  1. Chronic hepatitis C: treatment, complications, and long-term outcomes in a population of Latino veterans

    PubMed Central

    Santiago-Rolon, Amarilys; Purcell, Dagmary; Grigg, Nicole; Toro, Doris H.

    2016-01-01

    Objectives Chronic hepatitis C (CHC) is a major public health problem in Puerto Rico. It is the most common cause of chronic liver disease and the most frequent indication for liver transplantation in the United States." Our main objectives were to estimate the seroprevalence of CHC infection, to describe the demographic and histological parameters of the infection in our sample population, and to evaluate the treatment outcomes in Puerto Rican veterans. Methods To determine overall seroprevalence, we reviewed all the hepatitis C cases (encompassing from January 1, 2002, to December 31, 2009) of the VA Caribbean Healthcare System, Department of Veterans Affairs. The records of only those individuals who received treatment with pegylated interferon and ribavirin were reviewed to determine risks factors for infection, response rates, adverse events, and outcomes. Results During the study period, there were a total of 1,496 patients identified as being infected with HCV, for an estimated seroprevalence of 2.3%. Of these, approximately 10% (137) were treated with combination therapy and were included in this study. The mean age was 58 (±6.4); 96.4% were men. The most common genotype was type 1. The responses to treatment were generally poor, with only 48.4% of the patients achieving Ssustained virological response. Discussion Though the seroprevalence of chronic hepatitis C in the Latino veteran population of Puerto Rico is high, relatively few patients have received treatment, most probably because of the contraindications of the medications used. Combination therapy with pegylated interferon plus weight-based ribavirin was inefficient and plagued with side effects; as a whole, this therapy was not found to be overly beneficial to our patients. New emerging and approved therapies will change this paradigm, allowing the treatment of a larger population without the side effects of the studied therapy. PMID:26932282

  2. Factors influencing exercise participation by clients in long-term care.

    PubMed

    Ingrid, Brenner; Marsella, A

    Lack of participation in regular physical activity by the frail elderly is associated with a decline in physical functioning and an inability to carry out activities of daily living. This in turn, poses greater demands on nursing care that may be required by the client. This study explored factors that influence exercise adherence in frail elderly clients who are living in a long-term care facility. Twelve long-term care clients (5 males and 7 females), aged 74-95 years, participated in the study. Participants were divided into two groups according to their activity patterns (sedentary controls and regular exercisers) and completed a brief questionnaire addressing factors that have been associated with exercise adherence. Data analysis revealed two key factors which determined whether or not clients participated in physical activity programs. The amount of social support provided by significant others and the extent of chronic pain experienced by the client were the best predictors of engagement in regular exercise. Incorporating an understanding of these factors into nursing practice can help the nurse encourage regular physical activity in patients who are living in a long-term care setting. This in turn will help the client maintain his or her ability to carry out activities of daily living. PMID:19323001

  3. Risk factors for long-term mortality of Staphylococcus aureus bacteremia.

    PubMed

    Yahav, D; Yassin, S; Shaked, H; Goldberg, E; Bishara, J; Paul, M; Leibovici, L

    2016-05-01

    Staphylococcus aureus bacteremia (SAB) is a fatal disease. We aimed to describe risk factors for long-term mortality with SAB. We analyzed data from a retrospectively collected database including 1,692 patients with SAB. We considered variables of infection and background conditions for the analysis of long-term survival. The Kaplan-Meier procedure was used for analysis of long-term survival. Variables significantly associated with mortality were analyzed using a Cox regression model. We included 1,692 patients in the analysis. Patients were followed for up to 22 years. Within one year, 62% of patients died and within 5 years 72% died. A total of 82% of patients aged 65 years and older died within 5 years. Independent predictors of long-term mortality were older age (Hazard ratio 1.029, 95% confidence interval 1.022-1.036), female gender (HR 1.302, 95% CI 1.118-1.517), pneumonia or primary/ unknown source of infection (HR 1.441, 95% CI 1.230-1.689), dementia (HR 1.234, 95% CI 1.004-1.516), higher Charlson score (HR 1.155, 95% CI 1.115-1.196), shock at onset (HR 1.776, 95% CI 1.430-2.207) and arrival to hospitalization from an institution (HR 1.319, 95% CI 1.095-1.563). Long-term survival of patients older than 65 years and of women with SAB is severely curtailed. PMID:26873381

  4. Predictive Factors Affecting Long-Term Outcome of Unilateral Lateral Rectus Recession

    PubMed Central

    Yang, Hee Kyung; Kim, Mi-Jin; Hwang, Jeong-Min

    2015-01-01

    Background There are few long-term outcome reports of unilateral lateral rectus (LR) recession for exotropia including a large number of subjects. Previous reports on unilateral LR recession commonly show extremely low rates of initial overcorrection and large exodrifts after surgery suggesting that the surgical dose may be increased. However, little is known of the long-term outcome of a large unilateral LR recession for exotropia. Objectives To determine long-term outcomes and predictive factors of recurrence after a large unilateral LR recession in patients with exotropia. Data Extraction Retrospective analysis was performed on 92 patients aged 3 to 17 years who underwent 10 mm unilateral LR recession for exotropia of ≤ 25 prism diopters (Δ) with prism and alternate cover testing and were followed up for more than 2 years after surgery. Final success rates within 10Δ of exophoria/tropia and 5Δ of esophoria/tropia at distance in the primary position, improvement in stereopsis and the predictive factors for recurrence were evaluated. Results At 24 months after surgery, 54% of patients had ocular alignment meeting the defined criteria of success, 45% had recurrence and 1% had overcorrection. After a mean follow-up of 39 months, 36% showed success, 63% showed recurrence and 1% resulted in overcorrection. The average time of recurrence was 23.4±14.7 months (range, 1–60 months) and the rate of recurrence per person-year was 23% after unilateral LR recession. Predictive factors of recurrence were a larger preoperative near angle of deviation (>16Δ) and larger initial postoperative exodeviation (>5Δ) at distance. Conclusions Long-term outcome of unilateral LR recession for exotropia showed low success rates with high recurrence, thus should be reserved for patients with a small preoperative near angle of exodeviation. PMID:26418819

  5. Long-Term Effects of Childhood Risk Factors on Cardiovascular Health During Adulthood

    PubMed Central

    Shrestha, Roman; Copenhaver, Michael

    2015-01-01

    The primary purpose of this article is to provide a broad overview of the research on the long-term effects of childhood risk factors on cardiovascular diseases (CVDs) during adulthood and to outline recommendations for prevention of CVDs based on evidence-based interventions (EBIs). CVDs are the leading cause of death and a major cause of disability in the United States and globally. Risk factors for CVDs are already identifiable in children and youth, and include both modifiable factors (e.g., unhealthy diet, physical inactivity, tobacco smoking), and factors that cannot be changed (e.g., age, heredity, sex). A fundamental issue has been the severity of the long-term effects of childhood risk factors (i.e., behavioral and intermediate risk factors) on subsequent cardiovascular health. It is clear from the empirical evidence that risk factors for CVDs can develop during childhood and adolescence. These risk factors in childhood have been linked to adverse health outcomes, including CVDs, during adulthood. The findings thus far suggest that, in order to be effective and reduce the risk of adulthood CVDs, intervention strategies should begin during childhood. The findings also underscore the importance of adopting a healthy lifestyle as early in life as possible. PMID:26312015

  6. The long term economic impact of severe obstetric complications for women and their children in Burkina Faso.

    PubMed

    Ilboudo, Patrick G C; Russell, Steve; D'Exelle, Ben

    2013-01-01

    This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a "near miss" event). To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a) for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women's quality of life; b) for near miss women with perinatal death, on relatively expensive foods consumption and children's education and c) for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions. PMID:24224028

  7. Complications Associated with Long-Term Disposition of Newly-Generated Transuranic Waste: A National Laboratory Perspective

    SciTech Connect

    B.J. Orchard; L.A. Harvego; T.L. Carlson; R.P. Grant

    2009-03-01

    The Idaho National Laboratory (INL) is a multipurpose national laboratory delivering specialized science and engineering solutions for the U.S. Department of Energy (DOE). Sponsorship of INL was formally transferred to the DOE Office of Nuclear Energy, Science and Technology (NE) by Secretary Spencer Abraham in July 2002. The move to NE, and designation as the DOE lead nuclear energy laboratory for reactor technology, supports the nation’s expanding nuclear energy initiatives, placing INL at the center of work to develop advanced Generation IV nuclear energy systems; nuclear energy/hydrogen coproduction technology; advanced nuclear energy fuel cycle technologies; and providing national security answers to national infrastructure needs. As a result of the Laboratory’s NE mission, INL generates both contact-handled and remote-handled transuranic (TRU) waste from ongoing operations. Generation rates are relatively small and fluctuate based on specific programs and project activities being conducted; however, the Laboratory will continue to generate TRU waste well into the future in association with the NE mission. Currently, plans and capabilities are being established to transfer INL’s contact-handled TRU waste to the Advanced Mixed Waste Treatment Plant (AMWTP) for certification and disposal to the Waste Isolation Pilot Plant (WIPP). Remote-handled TRU waste is currently placed in storage at the Materials and Fuels Complex (MFC). In an effort to minimize future liabilities associated with the INL NE mission, INL is evaluating and assessing options for the management and disposition of all its TRU waste on a real-time basis at time of generation. This paper summarizes near-term activities to minimize future re handling of INL’s TRU waste, as well as, potential complications associated with the long-term disposition of newly-generated TRU waste. Potential complications impacting the disposition of INL newly-generated TRU waste include, but are not limited to

  8. Factors Affecting Antioxidant Response in Fish from a Long-term Mercury-Contaminated Reservoir.

    PubMed

    Sevcikova, M; Modra, H; Blahova, J; Dobsikova, R; Kalina, J; Zitka, O; Kizek, R; Svobodova, Z

    2015-11-01

    The objective of this work was to evaluate antioxidant defence and oxidative damage in organs (liver, gills, kidney, and brain) of five fish species (Aspius aspius, Esox lucius, Sander lucioperca, Abramis brama, Rutilus rutilus) from the long-term mercury-contaminated Skalka Reservoir in the Czech Republic. Special emphasis was placed on a comprehensive assessment of the factors that may affect the antioxidant response to mercury in fish. Antioxidant enzymes (glutathione reductase, glutathione peroxidase, and glutathione-S-transferase) did not significantly respond to mercury contamination. Levels of the analysed enzymes and oxidative damage to lipids were predominantly determined by a separate organ factor or species factor, or by the combination of both (p < 0.001). Levels of total glutathione and the reduced/oxidized glutathione ratio were influenced by mercury contamination in combination with their specific organ distribution (p < 0.001). Our results suggest that species and type of organ alone or in combination are more important factors than chronic exposure to mercury contamination with respect to effects on antioxidant defence in fish under field conditions. Our findings suggest that the main antioxidant defensive mechanism in fish from the studied long-term mercury contaminated site was the inter-tissue distribution of glutathione. PMID:26276034

  9. Epidermal hydration and skin surface lipids in patients with long-term complications of sulfur mustard poisoning

    PubMed Central

    Layegh, Pouran; Maleki, Masoud; Mousavi, Seyed Reza; Yousefzadeh, Hadis; Momenzadeh, Akram; Golmohammadzadeh, Shiva; Balali-Mood, Mahdi

    2015-01-01

    Background: Despite almost the three decades passed since the chemical attacks of Iraqi's army against the Iranian troops, some veterans are still suffering from long-term complications of sulfur mustard (SM) poisoning, including certain skin complaints specially dryness, burning, and pruritus. We thus aimed to evaluate the skin's water and lipid content in patients with a disability of >25% due to complications of SM poisoning and compare them with a matched control group. Materials and Methods: Sixty-nine male participants were included in this study; 43 SM-exposed patients, and 26 normal controls from their close relatives. The water and lipid content was measured in four different locations: Extensor and flexor sides of forearms and lateral and medial sides of legs by the Corneometer CM 820/Sebumeter SM 810. Collected data was analyzed and P ≤ 0.05 was considered as statistically significant. Results: The mean age of the patients and controls was 49.53 ± 11.34 (ranges: 40-71) and 29.08 ± 8.836 (ranges: 15-49 years), respectively. In the veterans group, the main cutaneous complaint was itching and skin dryness. Cherry angioma, dry skin, and pruritus were significantly more common in the SM-exposed cases than in the controls. (P = 0.01, 0.05, and 0.04, respectively). The moisture and lipid content of all areas were lower in the SM-exposed group, but it was only significant in skin sebum of lateral sides of legs (P = 0.02). Conclusion: Exposure to SM could decrease the function of stratum corneum and lipid production as a barrier, even after several years of its exposure. PMID:26622252

  10. Human factors and nuclear space technology in long-term exploration

    SciTech Connect

    Brown-VanHoozer, S.A.; VanHoozer, W.R.

    2000-07-01

    Allocation of manual versus automated tasks for operation and maintenance of nuclear power systems in space will be crucial at the onset and at the return of a space flight. Such factors as space adaptation syndrome (SAS), a temporary space motion sickness that has affected 40 to 50% of crew members on past space flights, can result in lost effort ranging from a few hours to a full day. This could have a significant impact on manual performance where high levels of execution are likely to be required in the very early stages of the mission. Other considerations involving higher-level behavioral phenomena such as interpersonal and group processes, individual belief systems, social and motivational factors, and (subjective) cognitive function have received little attention; nevertheless these will be essential elements for success in long-term exploration. Understanding that long-term space flight missions may create groups that become unique societies distinct unto themselves will test current ethical, moral, and social belief systems, requiring one to examine the amalgamation as well as organizational structures for the safety and balance of the crew.

  11. Tumor necrosis factor-alpha-induced apoptosis in hepatocytes in long-term culture.

    PubMed Central

    Bour, E. S.; Ward, L. K.; Cornman, G. A.; Isom, H. C.

    1996-01-01

    Apoptosis occurs naturally in the liver and increases in specific pathogenic processes. We previously described the use of a chemically defined medium supplemented with epidermal growth factor and dimethylsulfoxide to maintain rat hepatocytes in a highly differentiated state for more than 30 days (long-term culture). In this study, we showed that hepatocytes in long-term dimethylsulfoxide culture have definite advantages over using cells in short-term culture (cells in culture for 2 to 4 days) to study apoptosis. We demonstrated that treatment with tumor necrosis factor (TNF)-alpha induced apoptosis (detected morphologically and by formation of an oligonucleosomal DNA ladder) only in hepatocytes that had been subjected to dimethylsulfoxide removal. Neither treatment with TNF-alpha alone or dimethylsulfoxide removal alone induced apoptosis. Apoptosis could be induced by concentrations as low as 500 U of TNF-alpha/ml. Although a DNA ladder was not detected by 12 hours after TNF-alpha treatment, it was easily identified by 24 hours. We conclude that this system can be used 1) to examine the underlying mechanism by which TNF-alpha causes apoptosis in hepatocytes and 2) to study induction of apoptosis in hepatocytes by other agents. Images Figure 1 Figure 2 Figure 3 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:8579111

  12. Risk factors for deterioration of long-term liver function after radiofrequency ablation therapy

    PubMed Central

    Honda, Koichi; Seike, Masataka; Oribe, Junya; Endo, Mizuki; Arakawa, Mie; Syo, Hiroki; Iwao, Masao; Tokoro, Masanori; Nishimura, Junko; Mori, Tetsu; Yamashita, Tsutomu; Fukuchi, Satoshi; Muro, Toyokichi; Murakami, Kazunari

    2016-01-01

    AIM: To identify factors that influence long-term liver function following radiofrequency ablation (RFA) in patients with viral hepatitis-related hepatocellular carcinoma. METHODS: A total of 123 patients with hepatitis B virus- or hepatitis C virus-related hepatocellular car-cinoma (HCC) (n = 12 and n = 111, respectively) were enrolled. Cumulative rates of worsening Child-Pugh (CP) scores (defined as a 2-point increase) were examined. RESULTS: CP score worsening was confirmed in 22 patients over a mean follow-up period of 43.8 ± 26.3 mo. Multivariate analysis identified CP class, platelet count, and aspartate aminotransferase levels as signi-ficant predictors of a worsening CP score (P = 0.000, P = 0.011 and P = 0.024, respectively). In contrast, repeated RFA was not identified as a risk factor for liver function deterioration. CONCLUSION: Long-term liver function following RFA was dependent on liver functional reserve, the degree of fibrosis present, and the activity of the hepatitis condition for this cohort. Therefore, in order to maintain liver function for an extended period following RFA, suppression of viral hepatitis activity is important even after the treatment of HCC. PMID:27168872

  13. Understanding the Risk Factors and Long-Term Consequences of Cisplatin-Associated Acute Kidney Injury: An Observational Cohort Study.

    PubMed

    Bhat, Zeenat Yousuf; Cadnapaphornchai, Pravit; Ginsburg, Kevin; Sivagnanam, Milani; Chopra, Shamit; Treadway, Corey K; Lin, Ho-Sheng; Yoo, George; Sukari, Ammar; Doshi, Mona D

    2015-01-01

    Acute kidney injury (AKI) is a well-known complication of cisplatin-based chemotherapy; however, its impact on long-term patient survival is unclear. We sought to determine the incidence and risk factors for development of cisplatin-associated AKI and its impact on long-term renal function and patient survival. We identified 233 patients who received 629 cycles of high-dose cisplatin (99±9mg/m2) for treatment of head and neck cancer between 2005 and 2011. These subjects were reviewed for development of AKI. Cisplatin nephrotoxicity (CN) was defined as persistent rise in serum creatinine, with a concomitant decline in serum magnesium and potassium, in absence of use of nephrotoxic agents and not reversed with hydration. All patients were hydrated per protocol and none had baseline glomerular filtration rate (GFR) via CKD-EPI<60mL/min/1.73m2. The patients were grouped based on development of AKI and were staged for levels of injury, per KDIGO-AKI definition. Renal function was assessed via serum creatinine and estimated glomerular filtration rate (eGFR) via CKD-EPI at baseline, 6- and 12-months. Patients with AKI were screened for the absence of nephrotoxic medication use and a temporal decline in serum potassium and magnesium levels. Logistic regression models were constructed to determine risk factors for cisplatin-associated AKI. Twelve-month renal function was compared among groups using ANOVA. Kaplan-Maier curves and Cox proportional hazard models were constructed to study its impact on patient survival. Of 233 patients, 158(68%) developed AKI; 77 (49%) developed stage I, 55 (35%) developed stage II, and 26 (16%) developed stage III AKI. Their serum potassium and magnesium levels correlated negatively with level of injury (p<0.05). African American race was a significant risk factor for cisplatin-associated AKI, OR 2.8 (95% CI 1.3 to 6.3) and 2.8 (95% CI 1.2 to 6.7) patients with stage III AKI had the lowest eGFR value at 12 months (p = 0.05) and long-term

  14. Understanding the Risk Factors and Long-Term Consequences of Cisplatin-Associated Acute Kidney Injury: An Observational Cohort Study

    PubMed Central

    Bhat, Zeenat Yousuf; Cadnapaphornchai, Pravit; Ginsburg, Kevin; Sivagnanam, Milani; Chopra, Shamit; Treadway, Corey K.; Lin, Ho-Sheng; Yoo, George; Sukari, Ammar; Doshi, Mona D.

    2015-01-01

    Acute kidney injury (AKI) is a well-known complication of cisplatin-based chemotherapy; however, its impact on long-term patient survival is unclear. We sought to determine the incidence and risk factors for development of cisplatin-associated AKI and its impact on long-term renal function and patient survival. We identified 233 patients who received 629 cycles of high-dose cisplatin (99±9mg/m2) for treatment of head and neck cancer between 2005 and 2011. These subjects were reviewed for development of AKI. Cisplatin nephrotoxicity (CN) was defined as persistent rise in serum creatinine, with a concomitant decline in serum magnesium and potassium, in absence of use of nephrotoxic agents and not reversed with hydration. All patients were hydrated per protocol and none had baseline glomerular filtration rate (GFR) via CKD-EPI<60mL/min/1.73m2. The patients were grouped based on development of AKI and were staged for levels of injury, per KDIGO-AKI definition. Renal function was assessed via serum creatinine and estimated glomerular filtration rate (eGFR) via CKD-EPI at baseline, 6- and 12-months. Patients with AKI were screened for the absence of nephrotoxic medication use and a temporal decline in serum potassium and magnesium levels. Logistic regression models were constructed to determine risk factors for cisplatin-associated AKI. Twelve-month renal function was compared among groups using ANOVA. Kaplan-Maier curves and Cox proportional hazard models were constructed to study its impact on patient survival. Of 233 patients, 158(68%) developed AKI; 77 (49%) developed stage I, 55 (35%) developed stage II, and 26 (16%) developed stage III AKI. Their serum potassium and magnesium levels correlated negatively with level of injury (p<0.05). African American race was a significant risk factor for cisplatin-associated AKI, OR 2.8 (95% CI 1.3 to 6.3) and 2.8 (95% CI 1.2 to 6.7) patients with stage III AKI had the lowest eGFR value at 12 months (p = 0.05) and long-term

  15. Dosimetric Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

    SciTech Connect

    Caudell, Jimmy J.; Schaner, Philip E.; Desmond, Renee A.; Meredith, Ruby F.; Spencer, Sharon A.; Bonner, James A.

    2010-02-01

    Purpose: Intensification of radiotherapy and chemotherapy for head-and-neck cancer may lead to increased rates of dysphagia. Dosimetric predictors of objective findings of long-term dysphagia were sought. Methods and Materials: From an institutional database, 83 patients were identified who underwent definitive intensity-modulated radiotherapy for squamous cell carcinoma of the head and neck, after exclusion of those who were treated for a second or recurrent head-and-neck primary lesion, had locoregional recurrence at any time, had less than 12 months of follow-up, or had postoperative radiotherapy. Dosimetric parameters were analyzed relative to three objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy (PEG) tube dependence at 12 months, aspiration on modified barium swallow, or pharyngoesophageal stricture requiring dilation. Results: Mean dose greater than 41 Gy and volume receiving 60 Gy (V{sub 60}) greater than 24% to the larynx were significantly associated with PEG tube dependence and aspiration. V{sub 60} greater than 12% to the inferior pharyngeal constrictor was also significantly associated with increased PEG tube dependence and aspiration. V{sub 65} greater than 33% to the superior pharyngeal constrictor or greater than 75% to the middle pharyngeal constrictor was associated with pharyngoesophageal stricture requiring dilation. Conclusions: Doses to the larynx and pharyngeal constrictors predicted long-term swallowing complications, even when controlled for other clinical factors. The addition of these structures to intensity-modulated radiotherapy optimization may reduce the incidence of dysphagia, although cautious clinical validation is necessary.

  16. Long-term follow-up of the impacts on obstetric complications of trunk burn injuries sustained during childhood.

    PubMed

    Duke, Janine; Wood, Fiona; Semmens, James; Edgar, Dale W; Rea, Suzanne

    2012-01-01

    Limited data are available to assess the long-term effects of burns to the trunk sustained during early childhood on subsequent pregnancies. This population-based retrospective longitudinal study uses linked Western Australia hospital morbidity and midwives notification data for the period 1983-2008. During the study period, 824 girls younger than 15 years with non-erythema burns (partial thickness, full thickness, or unspecified burn depth) to the trunk were hospitalized in Western Australia. During the follow-up, 134 subjects with burns to the trunk during childhood were identified as having later pregnancies. The mean age at admission for burn injury was 5.7 ± 4.0 years, and the majority of burns were caused by scalds (51.5%) and flame (37.3%). For these subjects (N = 134), there were a total of 213 subsequent pregnancies. All pregnancies resulted in full-term live births. There were 142 (64.3%) vaginal deliveries, 26 (12.2%) breech or instrument, and 45 (21.2%) deliveries were by cesarean section. No admissions for scar conditions or revisions of burn scar or contracture were identified during any pregnancy (first to fourth) for subjects with burns to the trunk. Mode of delivery was not statistically significantly different from that experienced by subjects with burns sustained during childhood to other anatomical sites. For subjects in this study with less severe burns to the trunk, no specific detrimental impacts during pregnancy or delivery or to the fetus were identified. Further surveillance is required to gauge an accurate assessment of complications associated with severe trunk burns sustained during childhood. PMID:22269824

  17. Long-term evolution and predictive factors of mild inflammatory bowel disease.

    PubMed

    Reenaers, C; Pirard, C; Vankemseke, C; Latour, P; Belaiche, J; Louis, E

    2016-06-01

    Background Crohn's disease (CD) and ulcerative colitis (UC) are potentially progressive diseases. Few data are available on the prevalence and the factors associated with mild inflammatory bowel diseases (IBD). Aim Our aim was to assess the natural history of mild CD and mild UC and to identify predictive factors of mild evolution over the long term. Methods Retrospective study of IBD patients registered in the database of the university hospital CHU of Liège, Belgium. Mild CD was defined as an inflammatory luminal disease (no stricture, abdominal or perianal fistulae) requiring no immunomodulator (IM), anti-TNF and no surgery. Mild UC was defined as no requirement for IM, anti-TNF and no colectomy. Results Four hundred and seventy-three CD and 189 UC were included (median follow-up: 13 and 11 years respectively). At 1 year, 147 patients had mild CD. At 5 years and the maximum follow-up, 56% and 13% patients still had mild CD, respectively. At 1 year, 142 patients had mild UC. At 5 years and the maximum follow-up, 72% and 44% still had a mild UC, respectively. Factors associated with long-term mild CD and UC were older age at diagnosis and absence of corticosteroids in the first year. In UC proctitis location was associated with mild UC. Conclusions In this cohort, 90% of CD patients and 3/4 of UC with mild disease at 1 year lost their mild disease status over time. An old age at diagnosis was predictive of the persistence of a mild CD and UC. PMID:26815198

  18. Prognostic factors for long-term hearing preservation after canal-tympanoplasty for congenital aural atresia.

    PubMed

    Sakamoto, Takashi; Kikuta, Shu; Kikkawa, Yayoi S; Kinoshita, Makoto; Saito, Yuki; Kobayashi, Kenya; Kakigi, Akinobu; Suzuki, Mitsuya; Yamasoba, Tatsuya

    2015-11-01

    The present study aimed to determine favorable prognostic factors for long-term postoperative hearing outcome after canal-tympanoplasty for congenital aural atresia (CAA). We retrospectively reviewed pre and postoperative hearing results and image findings of 51 ears with CAA performed by canal-tympanoplasty for primary repair. Averages of the postoperative air and bone-conduction thresholds, and the air-bone gap (ABG) were calculated from the last pure-tone audiometry. Follow-up duration ranged from 16 to 139 months. A successful hearing result was defined as a postoperative ABG of ≤15 dB, or a postoperative pure-tone average of ≤30 dB. The influence of the following factors on the success of surgery was assessed by multivariate logistic regression analysis: total Jahrsdoerfer grading system score, age at surgery, and dimensions of middle ear including incudostapedial joint angulation, mesotympanic height, mesotympanic width, mesotympanic depth, mesotympanic area, mesotympanic volume, reconstructable external auditory canal (EAC) diameter, and reconstructable EAC height. Successful hearing outcomes were achieved in 24 of 51 ears (47.1%). A multivariate logistic regression analysis showed that an EAC area >72.3 mm(2) was the most significant favorable predictive factor (P = 0.006), followed by mesotympanic depth >5.5 mm (P = 0.013), mesotympanic height >4.6 mm (P = 0.016), and EAC diameter >9.5 mm (P = 0.029). In conclusion, the size of the reconstructable EAC and mesotympanum is important for predicting long-term favorable hearing outcome following canal-tympanoplasty for CAA. PMID:25323150

  19. Long-Term Follow-Up and Prognostic Factors for Advanced Thymic Carcinoma

    PubMed Central

    Wu, Jun-xin; Chen, Hui-qin; Shao, Ling-dong; Qiu, Su-fang; Ni, Qian-yu; Zheng, Bu-hong; Wang, Jie-zhong; Pan, Jian-ji; Li, Jin-luan

    2014-01-01

    Abstract The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival. We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma (Masaoka III and IV) in our institute, from December 2000 to 2012. Age, sex, clinical characteristics, laboratory findings, Masaoka and tumor node metastasis staging, pathologic grade, and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival (PFS) and the overall survival (OS) rates. Statistical analysis was conducted using SPSS, version 19.0 (SPSS, Inc, Chicago, IL). A total of 73 (81.1%) male and 17 (18.9%) female patients participated in the study. The median follow-up time was 75 months (range, 20–158 months). The 5-year PFS and OS rates were 23.6% (95% confidence interval [CI], 14.6%–33.8%) and 35.7% (95% CI, 25.1%–46.4%), respectively. The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase (LDH) level (P < 0.001), Masaoka III stage (P = 0.028), and radiotherapy (RT) (P < 0.001). The LDH (P < 0.001), T stage (P < 0.001), and the pathologic grade (P = 0.047) were independently prognostic of OS. Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS. LDH, Masaoka stage, and RT affected the PFS, and LDH, T stage, and pathologic grade seemed to affect the OS. Establishing a better staging system for predicting outcomes would be warranted. PMID:25526488

  20. Factors facilitating patient satisfaction among women with medically unexplained long-term fatigue: A relational perspective.

    PubMed

    Lian, Olaug S; Hansen, Anne Helen

    2016-05-01

    Bodily conditions that are difficult to identify, explain and treat with the aid of medical knowledge and technology appear to be particularly challenging to medical encounters. Patients are often dissatisfied with the help they receive, and they often experience that their medical needs are not met. To explore factors facilitating patient satisfaction among patients with a medically unexplained condition, we ask: what is the importance of individual versus relational factors in facilitating patient satisfaction in clinical encounters between general practitioners (GPs) and women with medically unexplained long-term fatigue? We approach this question through a statistical analysis of survey data collected from a net sample of 431 women recruited through a patient organisation for people suffering from myalgic encephalomyelitis in 2013. Participants were asked about their experiences with general practitioners in the Norwegian national health system in two different phases: shortly after illness onset, and current regular general practitioner last 12 months. The questions evolved around themes concerning shared understanding and decision making, being taken seriously, being paid due respect and being treated as an equal partner. Through descriptive statistics and multivariable logistic regression analyses, we explored how their experiences were related to individual and relational factors, respectively. Free-text comments from the questionnaires were used while interpreting the results. The analysis illuminates that relational aspects in medical encounters between GPs and ME patients, especially continuity, congruence in doctor-patient views and being seen by a specialist, are important catalysts of patient satisfaction. The probability of being satisfied with the initial investigation was more than six times higher in women who were referred to specialists, compared to those who were not. We conclude that continuity of care and experiences of being in a

  1. Sense of Community as a Protective Factor against Long-Term Psychological Effects of Childhood Violence

    PubMed Central

    Greenfield, Emily A.; Marks, Nadine F.

    2010-01-01

    This study uses a risk and resilience framework for conceptualizing the long-term effects of childhood family violence on mental health. It examines sense of community as a protective factor against adult psychological distress associated with experiences of physical or psychological violence in childhood from parents. Regression models are estimated using data from the 1995 National Survey of Midlife Development in the U.S. and from the 1996–97 National Study of Daily Experiences. Reported experiences of frequent psychological violence, regardless of the frequency of physical violence, is found to be positively associated with adult psychological distress. Adults’ sense of community is found to moderate the association between reports of both frequent psychological and frequent physical violence in childhood from parents and adult psychological distress. PMID:20454550

  2. Factors affecting electronic health record adoption in long-term care facilities.

    PubMed

    Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

    2008-01-01

    Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers. PMID:18411891

  3. Non-climatic factors and long-term, continental-scale changes in seasonally frozen ground

    NASA Astrophysics Data System (ADS)

    Shiklomanov, Nikolay I.

    2012-03-01

    ). In their recent paper entitled 'An observational 71-year history of seasonally frozen ground changes in Eurasian high latitudes', Frauenfeld and Zhang (2011) provided detailed analysis of soil temperature data to assess 1930-2000 trends in seasonal freezing depth. The data were obtained from 387 Soviet non-permafrost meteorological stations. The authors performed systematic, quality-controlled, integrative analysis over the entire former Soviet Union domain. The long-term changes in depth of seasonal freezing were discussed in relation to such forcing variables as air temperature, degree days of freezing/thawing, snow depth and summer precipitation as well as modes of the North Atlantic Oscillation. The spatially average approach adopted for the study provides a generalized continental-scale trend. The study greatly improves, expands and extends previous 1956-90 analysis of the ground thermal regime over the Eurasian high latitudes (Frauenfeld et al 2004). Although the work of Frauenfeld and Zhang (2011) is the most comprehensive assessment of the continental-scale long-term trends in seasonal freezing available to date, more detailed analysis is needed to determine the effect of climate change on seasonally frozen ground. It should be noted that, in addition to the variables considered for analysis, other non-climatic factors affect the depth of freezing propagation. Unlike the surface, which is influenced by the climate directly, the ground even at shallow depth receives a climatic signal that is substantially modified by edaphic processes, contributing to highly localized thermal sensitivities of the ground to climatic forcing. Subsurface properties, soil moisture, and snow and vegetation covers influence the depth of freezing. Topography also plays an important role in establishing the ground thermal regime. It is an important determinant of the amount of heat received by the ground surface, affects the distribution of snow and vegetation, and influences the

  4. Balancing Long-Term Risks of Ischemic and Bleeding Complications after Percutaneous Coronary Intervention with Drug-Eluting Stents

    PubMed Central

    Matteau, Alexis; Yeh, Robert; Camenzind, Edoardo; Steg, Ph. Gabriel; Wijns, William; Mills, Joseph; Gershlick, Anthony; de Belder, Mark; Ducrocq, Gregory; Mauri, Laura

    2015-01-01

    Introduction While trials comparing antiplatelet strategies after coronary intervention report average risks of bleeding and ischemia in a population, there is limited information to guide choices based on individual patient risks, particularly beyond one year after treatment. Methods Patient-level data from PROTECT, a broadly inclusive trial enrolling 8709 subjects treated with drug-eluting stents (sirolimus vs. zotarolimus-eluting stent), and PROTECT US, a single arm study including 1018 subjects treated with a zotarolimus-eluting stent were combined. The risk of ischemic events, cardiovascular death/non-periprocedural myocardial infarction (MI)/definite or probable stent thrombosis and the risk of bleeding events, GUSTO moderate or severe bleed were predicted using logistic regression, and the correlation between predicted ischemic and bleeding risks within individual patients was estimated. Results At median follow-up of 4.1 years, major bleeding occurred in 260 subjects (2.8%), and ischemic events in 595 (6.3%). Multivariate predictors of bleeding were: older age, smoking, diabetes mellitus, congestive heart failure, and chronic kidney disease (all p<0.05). Ischemic events shared all of the same predictors with bleeding events as well as: sex, BMI, prior MI, prior CABG, STEMI on presentation, stent length and sirolimus-eluting stent use (all p<0.05). Within individual subjects, bleeding and ischemic risks were strongly correlated (ρ=0.76, p<0.001). 97% of subjects had a greater risk of ischemic events than bleeding. Conclusions Individual patient risks of ischemia and bleeding are related to many common risk factors, yet the predicted risks of ischemic events are greater than those of major bleeding in the large majority of patients in long-term follow-up. PMID:26187674

  5. Possible nutrient limiting factor in long term operation of closed aquatic ecosystem

    NASA Astrophysics Data System (ADS)

    Hao, Zongjie; Li, Yanhui; Cai, Wenkai; Wu, Peipei; Liu, Yongding; Wang, Gaohong

    2012-03-01

    To investigate nutrient limitation effect on the community metabolism of closed aquatic ecosystem and possible nutrient limiting factors in the experimental food chains, depletion of inorganic chemicals including carbon, nitrogen and phosphorous was tested. A closed aquatic ecosystem lab module consisting of Chlorella pyrenoidosa and Chlamydomonas reinhardtii, Daphnia magna and associated unidentified microbes was established. Closed ecological systems receive no carbon dioxide; therefore, we presumed carbon as a first limiting factor. The results showed that the algae population in the nutrient saturated group was statistically higher than that in the nutrient limited groups, and that the chlorophyll a content of algae in the phosphorus limited group was the highest among the limited groups. However, the nitrogen limited group supported the most Daphnia, followed by the carbon limited group, the nutrient saturated group and the phosphorus limited group. Redundancy analysis showed that the total phosphorus contents were correlated significantly with the population of algae, and that the amount of soluble carbohydrate as feedback of nutrient depletion was correlated with the number of Daphnia. Thus, these findings suggest that phosphorus is the limiting factor in the operation of closed aquatic ecosystem. The results presented herein have important indications for the future construction of long term closed ecological system.

  6. Organizational factors influencing health information technology adoption in long-term-care facilities.

    PubMed

    Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

    2014-01-01

    Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary. PMID:24463588

  7. Weight Change and Associated Factors in Long-Term Breast Cancer Survivors

    PubMed Central

    Koo, Hye-Yeon; Seo, Young-Gyun; Cho, Mi-Hee; Kim, Min-Jung; Choi, Ho-Chun

    2016-01-01

    Purpose Weight gain often occurs after breast cancer diagnosis and significantly impacts the general health of cancer survivors. While the number of breast cancer survivors is increasing, few studies have reported data on weight change beyond 5 years post-diagnosis. We investigated weight change and associated factors in long-term survivors of breast cancer. Patients and Methods Medical records were reviewed on 1363 breast cancer patients and a total of 822 women who had survived beyond 5 years since diagnosis were included in the final analysis. The association between demographic, anthropometric, lifestyle, cancer related factors (including time since diagnosis, treatment modality, pathologic stage, and hormone receptor status), and weight-change over 5 years were examined. Results During an average 8.2 years of follow-up time, mean weight gain was 0.32kg (p = 0.017). 175 (21.3%) patients had gained more than 5% of their weight at diagnosis and their average gain was 5.55kg. Body mass index (BMI) at diagnosis, age at diagnosis, aromatase inhibitor (AI) use, heavy drinking, and type of surgery were associated with relative weight gain (≥5%) in univariate analysis (all p-values<0.05). Patients who were non-obese at diagnosis showed weight gain, while those who were obese at diagnosis lost weight (0.78kg,−1.11kg, respectively, p<0.001). In multivariate analysis, the non-obese group showed odds ratio of 2.7 (p = 0.001) relative to the obese group. Younger age group (age 18–54 years) showed odds ratio of 1.9 (p = 0.021) relative to the older age group (age 55–75 years), and patients who did not use AI showed odds ratio of 2.2 (p = 0.006) relative to women who did. Conclusion Long-term breast cancer survivors who were non-obese at diagnosis are more likely to gain weight than obese survivors. Younger survivors and survivors who have never used AI are also likely to gain weight. PMID:27391162

  8. Non-climatic factors and long-term, continental-scale changes in seasonally frozen ground

    NASA Astrophysics Data System (ADS)

    Shiklomanov, Nikolay I.

    2012-03-01

    ). In their recent paper entitled 'An observational 71-year history of seasonally frozen ground changes in Eurasian high latitudes', Frauenfeld and Zhang (2011) provided detailed analysis of soil temperature data to assess 1930-2000 trends in seasonal freezing depth. The data were obtained from 387 Soviet non-permafrost meteorological stations. The authors performed systematic, quality-controlled, integrative analysis over the entire former Soviet Union domain. The long-term changes in depth of seasonal freezing were discussed in relation to such forcing variables as air temperature, degree days of freezing/thawing, snow depth and summer precipitation as well as modes of the North Atlantic Oscillation. The spatially average approach adopted for the study provides a generalized continental-scale trend. The study greatly improves, expands and extends previous 1956-90 analysis of the ground thermal regime over the Eurasian high latitudes (Frauenfeld et al 2004). Although the work of Frauenfeld and Zhang (2011) is the most comprehensive assessment of the continental-scale long-term trends in seasonal freezing available to date, more detailed analysis is needed to determine the effect of climate change on seasonally frozen ground. It should be noted that, in addition to the variables considered for analysis, other non-climatic factors affect the depth of freezing propagation. Unlike the surface, which is influenced by the climate directly, the ground even at shallow depth receives a climatic signal that is substantially modified by edaphic processes, contributing to highly localized thermal sensitivities of the ground to climatic forcing. Subsurface properties, soil moisture, and snow and vegetation covers influence the depth of freezing. Topography also plays an important role in establishing the ground thermal regime. It is an important determinant of the amount of heat received by the ground surface, affects the distribution of snow and vegetation, and influences the

  9. [Early complications and long-term results of the LeVeen peritoneo-venous shunt in the treatment of refractory ascites].

    PubMed

    Arciero, G; Di Blasio, V; Botta, V; Rossi, M; Pigna, F; Di Tora, A

    1996-11-01

    Results concerning 14 cirrhotic patients who underwent LeVeen peritoneo-venous shunt for refractory or complicated ascites are discussed. The most relevant early complications regard coagulation disorders (35.7%) with a 14.3% postoperative mortality. The functional result appears largely satisfactory, also in terms of long-term efficiency. Utility of a wide evacuation of ascitic fluid during the operation is underlined. Ascites drainage at operation doesn't compromise shunt function or renal resumption, furthermore it may prevent some life-threatening complications like DIC, esophageal varices rupture and congestive heart failure. PMID:9072716

  10. Variability and Trends in Long Term Time Series and Correlations with Climate Factors

    NASA Astrophysics Data System (ADS)

    Pietrafesa, L. J.; Yan, T.; Bao, S.; Gayes, P. T.

    2014-12-01

    Employing credible data archives, we investigate 350 years of European land/atmospheric time series and 135 years of global oceanic and land/atmospheric time series. We reveal significant non-stationary and non-linear internal modes in the temporal data sets that include prominent signals at seasonal, annual, inter-annual, multi-annual, decadal, multi-decadal and trans-century time scales. We find an overall planetary warming. The overall trend is upwards, but the Global Surface Temperature Anomaly displays rates ranging from 0.8 oC/Century in 1659 to 0.0 in 1800 to 0.3 in 1880 and now at 1.0oC/Century; in deference to the IPCC 2007 Report which claimed ~ 2oC/Century. We relate the long term trends and variability of the temperature records correlatively with climate factors, such as the North Atlantic, Pacific Decadal, Atlantic Multi-Decadal, El Niño Southern, Arctic, Solar, Western Boundary Current, and other "Oscillations" and possible spatial-temporal links; and with the trend of fossil fuel burning.

  11. Short-term and long-term risk factors in gastric cancer.

    PubMed

    Verlato, Giuseppe; Marrelli, Daniele; Accordini, Simone; Bencivenga, Maria; Di Leo, Alberto; Marchet, Alberto; Petrioli, Roberto; Zoppini, Giacomo; Muggeo, Michele; Roviello, Franco; de Manzoni, Giovanni

    2015-06-01

    curative gastrectomy with D2/D3 lymphadenectomy. Survival curves in the two different histotypes (intestinal and mixed/diffuse) were superimposed in the first three years of follow-up and diverged thereafter. Likewise, survival curves as a function of site (fundus vs body/antrum) started to diverge after the first year. On the contrary, survival curves differed among age classes from the very beginning, due to different post-operative mortality, which increased from 0.5% in patients aged 65-74 years to 9.9% in patients aged 75-91 years; this discrepancy later disappeared. Accordingly, the proportional hazards assumption of the Cox model was violated, as regards age, site and histology. To cope with this problem, multivariable survival analysis was performed by separately considering either the first two years of follow-up or subsequent years. Histology and site were significant predictors only after two years, while T and N, although significant both in the short-term and in the long-term, became less important in the second part of follow-up. Increasing age was associated with higher mortality in the first two years, but not thereafter. Splitting survival time when performing survival analysis allows to distinguish between short-term and long-term risk factors. Alternative statistical solutions could be to exclude post-operative mortality, to introduce in the model time-dependent covariates or to stratify on variables violating proportionality assumption. PMID:26074682

  12. Factors influencing long-term outcomes in relapsing–remitting multiple sclerosis: PRISMS-15

    PubMed Central

    Kappos, Ludwig; Kuhle, Jens; Multanen, Juha; Kremenchutzky, Marcelo; Verdun di Cantogno, Elisabetta; Cornelisse, Peter; Lehr, Lorenz; Casset-Semanaz, Florence; Issard, Delphine; Uitdehaag, Bernard M J

    2015-01-01

    Aim An exploratory study of the relationship between cumulative exposure to subcutaneous (sc) interferon (IFN) β-1a treatment and other possible prognostic factors with long-term clinical outcomes in relapsing–remitting multiple sclerosis (RRMS). Methods Patients in the original PRISMS study were invited to a single follow-up visit 15 years after initial randomisation (PRISMS-15). Outcomes over 15 years were compared in the lowest and highest quartile of the cumulative sc IFN β-1a dose groups, and according to total time receiving sc IFN β-1a as a continuous variable per 5 years of treatment. Potential prognostic factors for outcomes were analysed. Results Of 560 patients randomised in PRISMS, 291 returned for PRISMS-15 and 290 (51.8%) were analysed. Higher cumulative dose exposure and longer treatment time appeared to be associated with better outcomes on: annualised relapse rate, number of relapses, time to Expanded Disability Status Scale (EDSS) progression, change in EDSS, proportions of patients with EDSS ≥4 or ≥6, ≤5 relapses and EDSS <4 or <6, and time to conversion to secondary-progressive MS (SPMS). Higher dose exposure was associated with lower proportions of patients with EDSS progression and conversion to SPMS, and longer time on treatment with lower risk of first relapse. Change in EDSS from baseline to 24 months was a strong predictor of evaluated clinical outcomes over 15 years. Conclusions These findings suggest that higher cumulative exposure to sc IFN β-1a may be associated with better clinical outcomes, and early change in EDSS score may have prognostic value, over many years, in RRMS. PMID:26374702

  13. Adoption factors associated with electronic health record among long-term care facilities: a systematic review

    PubMed Central

    Kruse, Clemens Scott; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, Ariana

    2015-01-01

    Objectives The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and secondary outcome measures Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. PMID:25631311

  14. Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients.

    PubMed

    Wang, Tao; Lu, Xiao-Jie; Chi, Jia-Chang; Ding, Min; Zhang, Yuan; Tang, Xiao-Yin; Li, Ping; Zhang, Li; Zhang, Xiao-Yu; Zhai, Bo

    2016-01-01

    This retrospective study aimed at evaluating the long-term outcomes and prognostic factors of microwave ablation (MWA) as a first-line treatment for hepatocellular carcinoma (HCC). 221 consecutive patients receiving MWA in our center between October 11, 2010 and December 31, 2013 were enrolled. Technique effectiveness was evaluated one month post-ablation. Initial complete ablation (CA1(st)) was gained in 201 (90.95%) patients, secondary CA (CA2(nd)) in 8 (3.62%) patients and the remaining 12 (5.43%) patients suffered from incomplete ablation (IA2(nd)) after two sessions of MWA. Patients with tumor size >5 cm were less likely to gain CA1(st). Procedure-related complications were recorded and no procedure-related death occurred. 22 (10.4%) complications occurred with 8 (3.8%) being major ones. Tumor characteristics (size, number, location) do not significantly influence complication rates. After a median follow-up of 41.0 (ranging 25.0-63.5) months, the median RFS and OS was 14.0 months (95% CI: 9.254-18.746) and 41.0 months (95% CI: 33.741-48.259) respectively. Multivariate analysis identified two significant prognosticators (levels of alpha fetal protein [AFP] and gamma-glutamyl transpeptidase [GGT]) of RFS and five significant prognosticators (tumor number, tumor size, AFP, GGT and recurrence type) of OS. In conclusion, MWA provides high technique effectiveness rate and is well tolerated in patients with HCC as a first-line treatment. PMID:27620527

  15. Factors that Influence Physical Activity in Long-Term Care: Perspectives of Residents, Staff, and Significant Others

    ERIC Educational Resources Information Center

    Benjamin, Kathleen; Edwards, Nancy; Guitard, Paulette; Murray, Mary Ann; Caswell, Wenda; Perrier, Marie Josee

    2011-01-01

    Physical activity has been linked to positive health outcomes for frail seniors. However, our understanding of factors that influence the physical activity of residents in the long-term care (LTC) setting is limited. This article describes our work with focus groups, one component of a multi-component study that examined factors influencing the…

  16. Interplay of Psychosocial Factors and the Long-Term Course of Adolescents with a Substance Use Disorder

    ERIC Educational Resources Information Center

    Winters, Ken C.; Stinchfield, Randy D.; Lee, Susanne; Latimer, William W.

    2008-01-01

    This paper examines the association of psychosocial factors and long-term drug use behaviors (year-5.5) among adolescents with a substance dependence disorder. One group received treatment with a 12-Step approach (n = 159) and one group was on a waiting list (n = 62). Four psychosocial factors (deviant behavior, peer drug environment,…

  17. Long term follow up of patients with anterior myocardial infarction complicated by left ventricular thrombus in the thrombolytic era.

    PubMed Central

    Mooe, T.; Teien, D.; Karp, K.; Eriksson, P.

    1996-01-01

    OBJECTIVES: To examine the appearance and resolution of left ventricular thrombi and to study the relation between thrombus and mortality during long term follow up after anterior myocardial infarction. DESIGN: Ninety nine consecutive patients were prospectively studied until the last included patient had been followed for one year. Streptokinase and aspirin were used routinely, anticoagulants only after a decision by the attending physician. Echocardiography was performed within 3 d of admission, before discharge, and after one, three, and 12 months. SETTING: Umeå University Hospital, a teaching hospital in Northern Sweden. MAIN OUTCOME MEASURES: Left ventricular thrombus, segmental myocardial function, and mortality during follow up. RESULTS: Thirty patients (30%) had a thrombus on discharge. One month, three months, and 12 months after hospital discharge, the thrombus had resolved in 81%, 84%, and 90% of the patients, respectively. The proportion of resolved thrombi at one month was high irrespective of whether anticoagulants were given (10/11, 91%) or not (12/16, 75%), P = 0.4. New thrombi appeared in 12 patients after discharge and resolution and reapperance of thrombi continued during the follow up period. Patients who developed a thrombus during the hospital stay (n = 44, 44%) had more extensive myocardial dysfunction on discharge (P < 0.001) and significantly higher mortality during the follow up period than those without a thrombus (23% v 7%, P < 0.01). CONCLUSIONS: With routine thrombolytic and aspirin treatment of anterior myocardial infarction, left ventricular thrombi usually resolve during the first month after hospital discharge. Appearance and resolution of thrombi continue, however, in a significant proportion of the patients during long term follow up. A left ventricular thrombus during the initial hospital stay is associated with high long term mortality. PMID:8800987

  18. Long-term cumulative survival and mechanical complications of single-tooth Ankylos Implants: focus on the abutment neck fractures

    PubMed Central

    2015-01-01

    PURPOSE To evaluate the cumulative survival rate (CSR) and mechanical complications of single-tooth Ankylos® implants. MATERIALS AND METHODS This was a retrospective clinical study that analyzed 450 single Ankylos® implants installed in 275 patients between December 2005 and December 2012. The main outcomes were survival results CSR and implant failure) and mechanical complications (screw loosening, fracture, and cumulative fracture rate [CFR]). The main outcomes were analyzed according to age, sex, implant length or diameter, bone graft, arch, and position. RESULTS The 8-year CSR was 96.9%. Thirteen (2.9%) implants failed because of early osseointegration failure in 3, marginal bone loss in 6, and abutment fracture in 4. Screw loosening occurred in 10 implants (2.2%), and 10 abutment fractures occurred. All abutment fractures were located in the neck, and concurrent screw fractures were observed. The CSR and rate of screw loosening did not differ significantly according to factors. The CFR was higher in middle-aged patients (5.3% vs 0.0% in younger and older patients); for teeth in a molar position (5.8% vs 0.0% for premolar or 1.1% for anterior position); and for larger-diameter implants (4.5% for 4.5 mm and 6.7% for 5.5 mm diameter vs 0.5% for 3.5 mm diameter) (all P<.05). CONCLUSION The Ankylos® implant is suitable for single-tooth restoration in Koreans. However, relatively frequent abutment fractures (2.2%) were observed and some fractures resulted in implant failures. Middle-aged patients, the molar position, and a large implant diameter were associated with a high incidence of abutment fracture. PMID:26813443

  19. Supporting and promoting personhood in long term care settings: contextual factors.

    PubMed

    Siegel, Elena O; Anderson, Ruth A; Calkin, Joy; Chu, Charlene H; Corazzini, Kirsten N; Dellefield, Mary E; Goodman, Claire

    2012-12-01

    The need for personhood-focused long-term care (LTC) is well-documented. A myriad of sociocultural, political, nursing/professional and organisational contexts facilitate or hinder registered nurses (RNs)' capacity to ensure personhood-focused LTC. Complexities derive from the countless interrelated aspects of these contexts, blurring clear distinctions of causality, responsibility and accountability. Context-related complexities were highlighted at a recent international conference attended by invited experts in LTC leadership from six countries (Canada, USA, England, Northern Ireland, New Zealand and Sweden). The group was convened to explore the value and contributions of RNs in LTC (McGilton, , International Journal of Older People Nursing 7, 282). The purpose of this paper is to expand the discussion of personhood-focused care beyond RNs, to contexts that influence the RN's capacity to ensure personhood-focused practices are embedded in LTC settings. Consistent with key topics covered at the international conference, we selected four major contexts for discussion in this paper: (i) sociocultural, (ii) public policy/financing/regulation, (iii) nursing/professional and (iv) organisational. For each context, we provide a brief description, literature and examples from a few countries attending the conference, potential impact on personhood-focused practices and RN strategies to facilitate personhood-focused care. The knowledge gained from attending to the influence of contextual factors on the RN's role in facilitating personhood-focused practices provides critical insights and directions for interventions aimed to maximise RN role effectiveness in LTC. In practice, understanding linkages between the various contexts offers indispensable insight for LTC nurse leaders charged with managing day-to-day operations and leading quality improvement initiatives that promote personhood-focused practices. PMID:23164251

  20. Increased body aluminum. An independent risk factor in patients undergoing long-term hemodialysis

    SciTech Connect

    Chazan, J.A.; Blonsky, S.L.; Abuelo, J.G.; Pezzullo, J.C.

    1988-08-01

    The clinical course and aluminum status of 38 patients who had been receiving dialysis for at least eight years and were still undergoing dialysis in 1985 were evaluated. Twenty-nine had evidence of increased aluminum burden, although only three had evidence of overt aluminum toxicity, and nine did not have evidence of increased aluminum burden. The patients in both the high- and low-aluminum group were similar with regard to age, the cause of their renal failure, presence of hypertension or coronary artery disease, previous parathyroidectomy, and a number of biochemical parameters, along with the amount of prescribed aluminum. All patients were followed up for the next two years or until they died. The amount of ingested aluminum was reduced, and in selected patients, treatment with intermittent infusions of deferoxamine mesylate was instituted. There were no deaths in the low-aluminum group, but ten of 29 died in the high-aluminum group: seven of vascular disease and three of infection. In addition, morbidity as defined by hospitalization for coronary or cerebral vascular disease or infection occurred in only two of the nine patients in the low-aluminum group and in 19 of the 29 patients in the high-aluminum group. These observations imply that the occurrence of increased body aluminum, as suggested by aluminum blood levels or by results of bone biopsies in some patients, has an adverse effect on morbidity and mortality and should be considered as a possible independent risk factor in patients who are receiving long-term hemodialysis.

  1. Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

    PubMed Central

    Im, Sang-Hyuk; Han, Young-Min; Kim, Jong-Tae; Chung, Dong Sup; Park, Young Sup

    2012-01-01

    Objective The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection. Methods A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion. Results The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04). Conclusion Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary. PMID:23133731

  2. Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

    PubMed Central

    Kienlein, Stefan; Schoening, Wenzel; Andert, Anne; Kroy, Daniela; Neumann, Ulf Peter; Schmeding, Maximilian

    2015-01-01

    AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation. METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation (LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side (SS), end-to-end (EE) anastomosis or hepeaticojejunostomy (HJ). Biliary complications (BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion (ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography (ERCP)]. Laboratory results included alanine aminotransferase (ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional (e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC. RESULTS: A total of 200 patients [age: 56 (19-72), alcoholic cirrhosis: n = 64 (32%), hepatocellular carcinoma: n = 40 (20%), acute liver failure: n = 23 (11.5%), cryptogenic cirrhosis: n = 22 (11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13 (6.5%), primary sclerosing cholangitis: n = 13 (6.5%), others: n = 25 (12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5% (n = 75

  3. Effect of Long-Term Physical Activity Practice after Cardiac Rehabilitation on Some Risk Factors

    ERIC Educational Resources Information Center

    Freyssin, Celine, Jr.; Blanc, Philippe; Verkindt, Chantal; Maunier, Sebastien; Prieur, Fabrice

    2011-01-01

    The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity…

  4. Canakinumab efficacy and long-term tocilizumab administration in tumor necrosis factor receptor-associated periodic syndrome (TRAPS).

    PubMed

    La Torre, Francesco; Muratore, Maurizio; Vitale, Antonio; Moramarco, Fulvio; Quarta, Laura; Cantarini, Luca

    2015-11-01

    Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominantly inherited autoinflammatory disease caused by mutations in the TNFRSF1A gene. Treatment is aimed at preventing acute disease attacks, improving quality of life, and preventing long-term complications such as systemic reactive amyloidosis. Biologic agents have significantly improved TRAPS management. In particular, interleukin 1 (IL-1) inhibition either with the recombinant IL-1 receptor antagonist anakinra or with the human IgG1 anti-IL-1β monoclonal antibody canakinumab has recently shown to induce a prompt and stable disease remission. Conversely, the successful experience with IL-6 inhibition is nowadays limited to a single patient. Anyway, introduction of new treatment options for patients requiring a lifelong therapy is desirable. We describe two TRAPS patients (son and father) successfully treated with canakinumab and tocilizumab, respectively. In particular, we highlight the clinical and laboratory efficacy as well as the good safety profile of tocilizumab during a 42-month follow-up period. PMID:26048626

  5. Skin Advanced Glycation End Products Glucosepane and Methylglyoxal Hydroimidazolone Are Independently Associated With Long-term Microvascular Complication Progression of Type 1 Diabetes

    PubMed Central

    Sun, Wanjie; Cleary, Patricia; Gao, Xiaoyu; Sell, David R.; Lachin, John

    2015-01-01

    Six skin collagen advanced glycation end products (AGEs) originally measured near to the time of the Diabetes Control and Complications Trial (DCCT) closeout in 1993 may contribute to the “metabolic memory” phenomenon reported in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. We have now investigated whether the addition of four originally unavailable AGEs (i.e., glucosepane [GSPNE], hydroimidazolones of methylglyoxal [MG-H1] and glyoxal, and carboxyethyl-lysine) improves associations with incident retinopathy, nephropathy, and neuropathy events during 13–17 years after DCCT. The complete 10-AGE panel is associated with three-step Early Treatment of Diabetic Retinopathy Study scale worsening of retinopathy (P ≤ 0.002), independent of either mean DCCT or EDIC study A1C level. GSPNE and fructose-lysine (furosine [FUR]) correlate with retinopathy progression, independently of A1C level. The complete panel also correlates with microalbuminuria (P = 0.008) and FUR with nephropathy independently of A1C level (P ≤ 0.02). Neuropathy correlates with the complete panel despite adjustment for A1C level (P ≤ 0.005). MG-H1 and FUR are dominant, independent of A1C level (P < 0.0001), whereas A1C loses significance after adjustment for the AGEs. Overall, the added set of four AGEs enhances the association of the original panel with progression risk of retinopathy and neuropathy (P < 0.04) but not nephropathy, while GSPNE and MG-H1 emerge as the principal new risk factors. Skin AGEs are robust long-term markers of microvascular disease progression, emphasizing the importance of early and sustained implementation of intensive therapy. PMID:25187362

  6. Skin advanced glycation end products glucosepane and methylglyoxal hydroimidazolone are independently associated with long-term microvascular complication progression of type 1 diabetes.

    PubMed

    Genuth, Saul; Sun, Wanjie; Cleary, Patricia; Gao, Xiaoyu; Sell, David R; Lachin, John; Monnier, Vincent M

    2015-01-01

    Six skin collagen advanced glycation end products (AGEs) originally measured near to the time of the Diabetes Control and Complications Trial (DCCT) closeout in 1993 may contribute to the "metabolic memory" phenomenon reported in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. We have now investigated whether the addition of four originally unavailable AGEs (i.e., glucosepane [GSPNE], hydroimidazolones of methylglyoxal [MG-H1] and glyoxal, and carboxyethyl-lysine) improves associations with incident retinopathy, nephropathy, and neuropathy events during 13-17 years after DCCT. The complete 10-AGE panel is associated with three-step Early Treatment of Diabetic Retinopathy Study scale worsening of retinopathy (P ≤ 0.002), independent of either mean DCCT or EDIC study A1C level. GSPNE and fructose-lysine (furosine [FUR]) correlate with retinopathy progression, independently of A1C level. The complete panel also correlates with microalbuminuria (P = 0.008) and FUR with nephropathy independently of A1C level (P ≤ 0.02). Neuropathy correlates with the complete panel despite adjustment for A1C level (P ≤ 0.005). MG-H1 and FUR are dominant, independent of A1C level (P < 0.0001), whereas A1C loses significance after adjustment for the AGEs. Overall, the added set of four AGEs enhances the association of the original panel with progression risk of retinopathy and neuropathy (P < 0.04) but not nephropathy, while GSPNE and MG-H1 emerge as the principal new risk factors. Skin AGEs are robust long-term markers of microvascular disease progression, emphasizing the importance of early and sustained implementation of intensive therapy. PMID:25187362

  7. Antibody-induced neutrophil depletion prior to the onset of pneumococcal meningitis influences long-term neurological complications in mice.

    PubMed

    Too, Lay Khoon; Mitchell, Andrew J; McGregor, Iain S; Hunt, Nicholas H

    2016-08-01

    During pneumococcal meningitis, clearance of bacteria by recruited neutrophils is crucial for host protection. However, these innate immune mechanisms are often insufficient and treatment with antibiotics is necessary to prevent death. Despite this antibiotic treatment, approximately half of all survivors suffer lifelong neurological problems. There is growing evidence indicating the harmful effects of neutrophils on CNS integrity. Therefore, the present study investigated the roles of neutrophils in the acute inflammatory response and the resulting long-term neuropsychological effects in murine pneumococcal meningitis. Long-term behavioural and cognitive functions in mice were measured using an automated IntelliCage system. Neutrophil depletion with antibody 1A8 as adjunctive therapy was shown to remarkably impair survival in meningitic C57BL/6J mice despite antibiotic (ceftriaxone) treatment. This was accompanied by increased bacterial load in the cerebrospinal fluid (CSF) and an increase in IL-1β, but decrease in TNF, within the CSF at 20h after bacterial inoculation. In the longer term, the surviving neutrophil-depleted post-meningitic (PM) mice displayed reduced diurnal hypolocomotion compared to PM mice treated with an isotype antibody. However, they showed nocturnal hyperactivity, and greater learning impairment in a patrolling task that is believed to depend upon an intact hippocampus. The data thus demonstrate two important mechanisms: 1. Neutrophil extravasation into the CNS during pneumococcal meningitis influences the pro-inflammatory response and is central to control of the bacterial load, an increase in which may lead to death. 2. Neutrophil-mediated changes in the acute inflammatory response modulate the neuropsychological sequelae in mice that survive pneumococcal meningitis. PMID:26965652

  8. Risk Factors for Fecal Colonization with Multiple Distinct Strains of Escherichia coli Among Long-Term Care Facility Residents

    PubMed Central

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N.

    2009-01-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with two or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest future efforts to efficiently identify diversity of colonizing strains will be challenging. PMID:19292660

  9. Transforming Growth Factor ß Recruits Persistent MAPK Signaling to Regulate Long-Term Memory Consolidation in "Aplysia Californica"

    ERIC Educational Resources Information Center

    Shobe, Justin; Philips, Gary T.; Carew, Thomas J.

    2016-01-01

    In this study, we explore the mechanistic relationship between growth factor signaling and kinase activity that supports the protein synthesis-dependent phase of long-term memory (LTM) consolidation for sensitization of "Aplysia." Specifically, we examine LTM for tail shock-induced sensitization of the tail-elicited siphon withdrawal…

  10. Four-year weight losses in the Look AHEAD study: Factors associated with long-term success

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long-term success. A total of 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle ...

  11. Aggression in Childhood and Long-Term Unemployment in Adulthood: A Cycle of Maladaptation and Some Protective Factors.

    ERIC Educational Resources Information Center

    Kokko, Katja; Pulkkinen, Lea

    2000-01-01

    Examined risk mechanisms and protective factors in the relation between aggression in childhood and long-term adult unemployment among participants in the Jyvaskyla Longitudinal Study of Personality and Social Development. Found that aggression at 8 years predicted school maladjustment at age 14, which was related to unemployment. Child-centered…

  12. Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

    PubMed

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

    2009-05-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging. PMID:19292660

  13. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis.

    PubMed

    Peolsson, Anneli; Peolsson, Michael

    2008-03-01

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12-24) for short-term follow-up and 76 months (range 56-94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A "preoperative" low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF. PMID:18084782

  14. Common Factors Predicting Long-term Changes in Multiple Health Behaviors

    PubMed Central

    BLISSMER, BRYAN; PROCHASKA, JAMES O.; VELICER, WAYNE F.; REDDING, COLLEEN A.; ROSSI, JOSEPH S.; GREENE, GEOFFREY W.; PAIVA, ANDREA; ROBBINS, MARK

    2010-01-01

    This study was designed to assess if there are consistent treatment, stage, severity, effort and demographic effects which predict long-term changes across the multiple behaviors of smoking, diet and sun exposure. A secondary data analysis integrated data from four studies on smoking cessation (N = 3927), three studies on diet (N = 4824) and four studies on sun exposure (N = 6465). Across all three behaviors, behavior change at 24 months was related to treatment, stage of change, problem severity and effort effects measured at baseline. There were no consistent demographic effects. Across multiple behaviors, long-term behavior changes are consistently related to four effects that are dynamic and open to change. Behavior changes were not consistently related to static demographic variables. Future intervention research can target the four effects to determine if breakthroughs can be produced in changing single and multiple behaviors. PMID:20207664

  15. Possible Limiting Nutrient Factor in Long Term Operation of Closed Aquatic Ecosystem

    NASA Astrophysics Data System (ADS)

    Hao, Zongjie; Wang, Gaohong; Liu, Yongding

    A lab mini-module of Closed Aquatic Ecosystem consisting of Chlorella pyrenoidosa and Bulinus australianus was constructed to study the effect of nutrient limitation on long term operation. A series of tests were taken, the first introduced was consumer part Bulinus australianus, the second nutrient introduced was inorganic carbon source, organic carbon source glucose was injected into a third set of the systems, The fourth one is Chlorella pyrenoidosa only, acting as the control.Results showed the one with Bulinus australianus came to a steady state 17 days after closure, and algae in those introduced carbon source grew better than monoculture. It is inferred that nutrient limitation is inevitable in Long term operation of Closed Aquatic Ecosystem, especially carbon which is partly restored as carbon pool is out of element cycle.

  16. Prognostic factors for long term survival in patients with advanced non-small cell lung cancer

    PubMed Central

    Moumtzi, Despoina; Lampaki, Sofia; Porpodis, Konstantinos; Lagoudi, Kalliopi; Hohenforst-Schmidt, Wolfgang; Pataka, Athanasia; Tsiouda, Theodora; Zissimopoulos, Athanasios; Lazaridis, George; Karavasilis, Vasilis; Timotheadou, Helen; Barbetakis, Nikolaos; Pavlidis, Pavlos; Kontakiotis, Theodoros; Zarogoulidis, Konstantinos

    2016-01-01

    Background Non-small cell lung cancer (NSCLC) represents 85% of all lung cancers. It is estimated that 60% of patients with NSCLC at time of diagnosis have advanced disease. The aim of this study was to investigate clinical and demographic prognostic factors of long term survival in patients with unresectable NSCLC. Methods We retrospectively reviewed data of 1,156 patients with NSCLC stage IIIB or IV who survived more than 60 days from the time of diagnosis and treated from August 1987 until March 2013 in the Oncology Department of Pulmonary Clinic of the General Hospital Papanikolaou. Initially univariate analysis using the log-rank test was conducted and then multivariate analysis using the proportional hazards model of Cox. Also Kaplan Meier curves were used to describe the distribution of survival times of patients. The level of significance was set at 0.05. Results The mean age at diagnosis was 62 years. About 11.9% of patients were women and 88.1% were male. The majority of cases were adenocarcinomas (42.2%), followed squamous (33%) and finally the large cell (6%). Unlike men, most common histological type among women was adenocarcinoma rather than squamous (63% vs. 10.9%). In univariate analysis statistically significant factors in the progression free survival (PFS) and overall survival (OS) were: weight loss ≥5%, histological type, line 1 drugs, line 1 combination, line 1 cycles and radio lung. Specifically radio lung gives clear survival benefit in the PFS and OS in stage IIIB (P=0.002) and IV (P<0.001). On the other hand, the number of distant metastases in stage IV patients did not affect OS, neither PFS. In addition patients who received platinum and taxane had better PFS (P=0.001) and OS (P<0.001) than those who received platinum without taxane. Also the third drug administration proved futile, since survival (682.06±34.9) (P=0.023) and PFS (434.93±26.93) (P=0.012) of patients who received less than three drugs was significantly larger. Finally

  17. Blastocystis hominis infection in long-term care facilities in Taiwan: prevalence and associated clinical factors.

    PubMed

    Su, Fu-Hsiung; Chu, Fang-Yeh; Li, Chung-Yi; Tang, Hui-Fei; Lin, Yu-Shiang; Peng, Yu-Ju; Su, Yih-Ming; Lee, Shyh-Dye

    2009-10-01

    Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection. PMID:19488784

  18. Factors affecting short- and long-term outcomes of manipulation under anaesthesia in patients with adhesive capsulitis of the shoulder

    PubMed Central

    Owen, John M; Sayers, Adrian E; Woods, David A

    2014-01-01

    Background The present study aimed to evaluate and determine the factors that affect short- and long-term outcome following manipulation under anaesthesia (MUA) of patients with adhesive capsulitis. Methods Patients recruited from January 1999 to January 2010 were retrospectively analyzed and classified as having primary or secondary adhesive capsulitis. All patients were assessed for range of movement (ROM) and Oxford Shoulder Scores (OSS) before and immediately postoperatively, as well as for OSS more than 1 year post MUA. Results In total, 295 patients (315 shoulders) were sequentially recruited, and information was collected at baseline, as well as at a mean follow-up of 28 days and 3.6 years. A significant improvement in OSS and ROM was noted 1 month post MUA (p < 0.0001) with females benefiting more than males (p < 0.0025). Long-term follow-up revealed that the improvement in OSS was maintained (p < 0.0001). Secondary adhesive capsulitis significantly reduced the efficacy of MUA as assessed by ROM (p < 0.0001). Other factors (age, initial ROM and OSS, and length of symptoms prior to MUA) did not significantly affect the outcome over the short- or long-term. Conclusions The findings of the present study show that all patient groups had a significantly improved ROM and OSS in the short-term with long-term maintenance of improved OSS.

  19. The severe complication of Stevens–Johnson syndrome induced by long-term clozapine treatment in a male schizophrenia patient: a case report

    PubMed Central

    Wu, Ming-Kung; Chung, Weilun; Wu, Ching-Kuan; Tseng, Ping-Tao

    2015-01-01

    Introduction: Stevens–Johnson syndrome (SJS) is a severe adverse drug reaction that can result in disability and mortality. SJS is defined as having a widespread distribution throughout the whole body surface area with <10% extent of skin detachment and skin lesions. Some drugs, such as carbamazepine, have been reported to have a greater correlation to SJS. Although clozapine use has been mentioned as a risk factor for development of SJS, no report has clearly described the features of SJS as a reaction to clozapine use. Herein, we report the case of a patient presenting SJS after long-term clozapine treatment. Case report: Mr A was a 54-year-old male with a diagnosis of chronic schizophrenia. He was hospitalized in a mental institute and received clozapine 200 mg/day for 2 years, without discomfort or drug side effects. He developed acute-onset mouth edema, multiple oral and ocular ulcers, oral and ocular mucosa swelling, and multiple erythematous skin rashes over his entire body and extremities with hypertension and high fever. SJS was diagnosed after referral to a general hospital. Results The SJS subsided under supportive treatment. Conclusion Accumulated lymphocytes and macrophages in the epidermis and elevated TNF-α might cause an immune reaction and apoptosis and result in the clinical presentation of SJS. Clozapine is believed to modulate the immunologic reaction, and therefore might induce SJS through immunomodulation. This case highlights the importance of considering the possibility of SJS resulting from the use of drugs for which there are no reports of such a severe complication. PMID:25914536

  20. Excision of an epidermal inclusion cyst: Correction of a long-term complication of female genital circumcision.

    PubMed

    Dun, Erica C; Ackerman, Christina; Cutler, Abigail; Lakhi, Nisha A

    2016-06-01

    Epidermal inclusion cysts are a late complication of female genital circumcision, which is a practice that affects 125 million women primarily from Africa and the Middle East. A 30-year-old woman, gravida 4, para 1, presented to our clinic with an 8-year history of a slowly enlarging periclitoral mass. The patient had undergone female genital circumcision at the age of 5 years. We describe and video-illustrate the surgical technique of excising the 8-cm epidermal inclusion cyst. Using this technique, the entire cyst was resected intact, excess vulvar skin removed, and defect repaired. Postoperatively, she had minimal pain, no dyspareunia, and good cosmesis. Restoration of anatomy for this late complication of female genital circumcision is achievable with knowledge of anatomy, adherence to basic surgical principles that include tension-free closure, and close postoperative follow up. PMID:27001220

  1. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias.

    PubMed

    Jean, G; Charra, B; Chazot, C; Vanel, T; Terrat, J C; Hurot, J M; Laurent, G

    2002-07-01

    Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients. Bacteremia (n = 56) occurred at least once with 37 (29%) of the catheters (an incidence of 1.1/1,000 catheter-days); local infection (n = 45, 1/1,000 catheter-days) was associated with bacteremia in 18 cases. Death in 1 case was directly related to Staphylococcus aureus (SA) septic shock, and septicemia contributed to deaths in 2 additional cases. Catheters were removed in 48% of the bacteremic episodes. Treatment comprised intravenous double antimicrobial therapy for 15-20 days. Bacteriological data of bacteremia showed 55% involvement of SA. Nasal carriage of SA was observed in 35% of the patients with catheters. Bacteremic catheters were more frequently observed in patients with diabetes mellitus (p = 0.03), peripheral atherosclerosis (p = 0.001), a previous history of bacteremia (p = 0.05), nasal carriage of SA (p = 0.0001), longer catheter survival time (p = 0.001), higher total intravenous iron dose (p = 0.001), more frequent urokinase catheter infusion (p < 0.01), and local infection (p < 0.001) compared with non-bacteremic catheters. Monovariate survival analysis showed that significant initial risk factors for bacteremia were nasal carriage of SA (p = 0.00001), previous bacteremia (p = 0.0001), peripheral atherosclerosis (p = 0.005), and diabetes (p = 0.04). This study confirms the relatively high incidence of bacteremia with tunneled double-lumen silicone catheters and its potential complications. Possible preventive actions are discussed according to the risk factors. PMID:12119469

  2. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care settings.

    PubMed

    Wainwright, Susan Flannery; McGinnis, Patricia Quinn

    2009-01-01

    The purpose of this qualitative research was to evaluate the reasoning of clinicians practicing in long-term care facilities and to explore factors influencing their professional development. Eighteen participants were recruited from eight clinical sites and included seven occupational therapists, eight physical therapists, and three speech therapists distributed across three groups relative to experience. Nonparticipant observation and videotape of therapist-patient interactions were used in semi-structured interviews with each participant. Qualitative data analysis software was used during a process of open and axial coding, followed by thematic analysis. The facilitory and inhibitory factors that affect clinical reasoning and professional development were identified. Rehabilitation professionals in long-term care demonstrated clinical reasoning within the context of patient-centered goals. Well-developed and explicit programs for mentorship, professional development, and continuing education fostered their clinical reasoning abilities. Participants perceived that these factors were vital to achieving optimal patient outcomes. PMID:19753425

  3. Synergy between interleukin-2 and a second factor in the long-term growth of human T cells.

    PubMed Central

    Mills, B J; Shively, J E; Mitsky, P S; Hawke, D H; Forman, S J; Wright, C L; Todd, C W

    1986-01-01

    It has recently been shown that factors in addition to interleukin-2 (IL-2) are required for the proliferation or differentiation of at least some murine T-cell lines. We have previously shown that conditioned medium from human mononuclear cells stimulated with phorbol ester and staphylococcal enterotoxin A is superior to commercial sources of IL-2 for the long-term growth of human T cells. We have identified in these supernatants a non-IL-2 factor (synergistic factor, SF) which synergizes with JURKAT IL-2 in the long-term growth of human T cells. [3H]TdR incorporation by IL-2-dependent human T cells after growth in IL-2 or SF alone for 14 days was slight, but significant. By contrast, growth in a combination of SF and IL-2 for 14 days stimulated [3H]TdR incorporation 10-20-fold higher, generally equal to the high incorporation measured when cells were grown in the presence of the conditioned medium from which SF was obtained. In a standard 2-day IL-2 assay, there was no correlation between activity and long-term growth-promoting ability. These results suggest that the 14-day assay better discerns the growth-promoting activity of various factors or combinations of factors. The mechanism of this interaction between SF and IL-2 remains to be elucidated. It is clear, however, that T-cell growth factor activity, when assessed by the long-term growth of human T cells, is not due to interleukin-2 alone. PMID:3489670

  4. Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer

    SciTech Connect

    Caudell, Jimmy J.; Schaner, Philip E.; Meredith, Ruby F.; Locher, Julie L.; Nabell, Lisle M.; Carroll, William R.; Magnuson, J. Scott; Spencer, Sharon A.; Bonner, James A.

    2009-02-01

    Purpose: The use of altered fractionation radiotherapy (RT) regimens, as well as concomitant chemotherapy and RT, to intensify therapy for locally advanced head-and-neck cancer can lead to increased rates of long-term dysphagia. Methods and Materials: We identified 122 patients who had undergone definitive RT for locally advanced head-and-neck cancer, after excluding those who had been treated for a second or recurrent head-and-neck primary, had Stage I-II disease, developed locoregional recurrence, had <12 months of follow-up, or had undergone postoperative RT. The patient, tumor, and treatment factors were correlated with a composite of 3 objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy tube dependence at the last follow-up visit; aspiration on a modified barium swallow study or a clinical diagnosis of aspiration pneumonia; or the presence of a pharyngoesophageal stricture. Results: A composite dysphagia outcome occurred in 38.5% of patients. On univariate analysis, the primary site (p = 0.01), use of concurrent chemotherapy (p = 0.01), RT schedule (p = 0.02), and increasing age (p = 0.04) were significantly associated with development of composite long-term dysphagia. The use of concurrent chemotherapy (p = 0.01), primary site (p = 0.02), and increasing age (p = 0.02) remained significant on multivariate analysis. Conclusion: The addition of concurrent chemotherapy to RT for locally advanced head-and-neck cancer resulted in increased long-term dysphagia. Early intervention using swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated RT to reduce the dose to the uninvolved swallowing structures should be explored further in populations at greater risk of long-term dysphagia.

  5. Congenital rubella pneumonitis complicated by Pneumocystis jiroveci infection with positive long term respiratory outcome: a case report and literature review.

    PubMed

    Sanchez, M O; Chang, A B

    2009-12-01

    Rubella remains to be a significant illness in the developing countries because of limited access to immunizations. In congenital rubella syndrome, lung involvement becomes evident within the few months of life, as a manifestation of the "late onset rubella syndrome." The lungs and other organs become involved secondary to immunopathologic mechanisms and immunodeficiency predisposes affected patients to opportunistic pathogens. We report the clinical, respiratory and immunologic data of a young boy who developed rubella pneumonitis and concomitant infection with Pneumocystis jiroveci. Despite the complicated clinical course, the child survived. At follow-up he has a normal pulmonary examination, mild hyperinflation only on his chest radiograph, normal immunology and normal respiratory reactance and resistance. PMID:19911369

  6. Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study

    PubMed Central

    Ehling, Rainer; Lutterotti, Andreas; Hegen, Harald; Di Pauli, Franziska; Auer, Michael; Deisenhammer, Florian; Reindl, Markus; Berger, Thomas

    2016-01-01

    Background Multiple sclerosis (MS) has a highly heterogenic course making prediction of long term outcome very difficult. Objective The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset. Methods This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5), moderate (EDSS 3.0–5.5) or severe (EDSS ≥6.0) disability were calculated to correct for confounders. Results Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0–1580.1); p<0.001). Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23–0.77; p = 0.005), while depression (HR 3.59; CI 1.14–11.24; p = 0.028) and cognitive dysfunction (HR 4.64; CI 1.11–19.50; p = 0.036) 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability. Conclusion We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms. PMID:27391947

  7. Long-Term Outcomes and Prognostic Factors for Patients with Endoscopy-Negative Iron Deficiency

    PubMed Central

    Soon, Anny; Cohen, Benjamin L.; Groessl, Erik J.

    2016-01-01

    Background and Aim Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA. Methods This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002–2004 at the VA San Diego Healthcare System. Results Mean age was 69.3 years (range 42–93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure. Conclusions Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations. PMID:22945477

  8. Adult severe haemophilia A patients under long-term prophylaxis with factor VIII in routine clinical practice.

    PubMed

    Mingot-Castellano, María E; González-Díaz, Laura; Tamayo-Bermejo, Rocio; Heiniger-Mazo, Anabel I

    2015-07-01

    There is no clear consensus on the best practice for long-term prophylaxis in adults with severe haemophilia A. This is a single-centre prospective case series study. We describe here the demographic data, type and reason of prophylaxis in adult patients (>18 years old) with severe (<1%) haemophilia A, treated in our centre from 2006 to 2013. Prophylaxis was tailored according to pharmacokinetic studies and posterior factor VIII (FVIII) trough level adjustment. We analysed FVIII consumption, bleeding rate, adherence and adverse events in this group of patients. In adult patients who initiated long-term prophylaxis during this period, we compared FVIII consumption and bleeding rate with the previous on-demand period. We analysed data from 18 patients. Median annual FVIII consumption was 2374.2 IU/kg/year. Among the patients receiving tertiary prophylaxis, initiated from 2006 onwards, the annual FVIII consumption was 2557.8 vs. 1696.8 IU/kg per year during the on-demand period (P = 0.312). In this group of patients, there was a decrease in annual bleeding events of 88.3% during prophylaxis compared with the on-demand therapy (P < 0.0001). A high adherence to prophylaxis was observed (84%). No cases of anaphylaxis or symptomatic thromboembolic events were recorded. In adult severe haemophilia A patients, the type of and reason to indicate long-term prophylaxis are diverse nowadays. FVIII consumption varies depending on the justification of prophylaxis. The observations reported provide further support for the efficacy of long-term prophylaxis in adult haemophilia A patients. PMID:25767895

  9. Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk.

    PubMed

    Bao, Ting; Basal, Coby; Seluzicki, Christina; Li, Susan Q; Seidman, Andrew D; Mao, Jun J

    2016-09-01

    Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with chemotherapy, but researchers rarely study its risk factors, fall risk, and prevalence in long-term breast cancer survivors. We aimed to determine CIPN prevalence, risk factors, and association with psychological distress and falls among long-term breast cancer survivors. We conducted Cross-sectional analyses among postmenopausal women with a history of stage I-III breast cancer who received taxane-based chemotherapy. Participants reported neuropathic symptoms of tingling/numbness in hands and/or feet on a 0-10 numerical rating scale. We conducted multivariate logistic regression analyses to evaluate risk factors associated with the presence of CIPN and the relationship between CIPN and anxiety, depression, insomnia, and patient-reported falls. Among 296 participants, 173 (58.4 %) reported CIPN symptoms, 91 (30.7 %) rated their symptoms as mild, and 82 (27.7 %) rated them moderate to severe. Compared with women of normal weight, being obese was associated with increased risk of CIPN (adjusted OR 1.94, 95 % CI: 1.03-3.65). Patients with CIPN reported greater insomnia severity, anxiety, and depression than those without (all p < 0.05). Severity of CIPN was associated with higher rates of falls, with 23.8, 31.9, and 41.5 % in the "no CIPN," "mild," and "moderate-to-severe" groups, respectively, experiencing falls (p = 0.028). The majority of long-term breast cancer survivors who received taxane-based chemotherapy reported CIPN symptoms; obesity was a significant risk factor. Those with CIPN also reported increased psychological distress and falls. Interventions need to target CIPN and comorbid psychological symptoms, and incorporate fall prevention strategies for aging breast cancer survivors. PMID:27510185

  10. Risk and Protective Factors Influencing Life Skills among Youths in Long-Term Foster Care.

    ERIC Educational Resources Information Center

    Nollan, K. A.; Pecora, P. J.; Nurius, P. N.; Whittaker, J. K.

    2002-01-01

    Examined through mail surveys of youth, parents, and social workers the predictive value of selected risk and protective factors in explaining self-sufficiency skills of 219 ethnically diverse 12- to 15-year-olds in foster care. Found that protective factors related to greater self-sufficiency skills, and risk factors were negatively associated.…

  11. Factors Affecting Grammatical and Lexical Complexity of Long-Term L2 Speakers' Oral Proficiency

    ERIC Educational Resources Information Center

    Lahmann, Cornelia; Steinkrauss, Rasmus; Schmid, Monika S.

    2016-01-01

    There remains considerable disagreement about which factors drive second language (L2) ultimate attainment. Age of onset (AO) appears to be a robust factor, lending support to theories of maturational constraints on L2 acquisition. The present study is an investigation of factors that influence grammatical and lexical complexity at the stage of L2…

  12. Long term complications of diabetes

    MedlinePlus

    ... as possible. Steps may include: A healthy diet Exercise Medicines You may need to check your blood sugar ... Your doctor may ask you to take a medicine called a statin to ... you. Regular exercise is good for people with diabetes. Talk to ...

  13. PTA of Infrapopliteal Arteries: Long-term Clinical Follow-up and Analysis of Factors Influencing Clinical Outcome

    SciTech Connect

    Peregrin, Jan H. Koznar, Boris; Kovac, Josef; Lastovickova, Jarmila; Novotny, Jiri; Vedlich, Daniel; Skibova, Jelena

    2010-08-15

    This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.

  14. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.

    PubMed

    Lagier, D; Platon, L; Chow-Chine, L; Sannini, A; Bisbal, M; Brun, J-P; Blache, J-L; Faucher, M; Mokart, D

    2016-09-01

    Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome. PMID:27418297

  15. Long-Term Data Reveal Rate and Risk Factors for Subsequent Surgeries Following Initial ACL Reconstruction

    MedlinePlus

    ... we have not known the rate and risk factors for subsequent knee surgery until now,” said senior author Kurt Spindler, M.D., of Vanderbilt University. In the Multicenter Orthopaedic Outcomes Network (MOON) study, ...

  16. A Quantitative Analysis of Factors That Influence Participation in Continuing Education among Nurses Employed in Long-Term Care Facilities

    ERIC Educational Resources Information Center

    Murray, Rhoda R.

    2013-01-01

    As the American population ages, the need for more long-term care services will increase. The elderly who are afflicted with a number of chronic illnesses predominantly use long-term care services. By 2020, 12 million older Americans will need long-term care services, and those 65 and older have a 40% chance of entering some type of long-term care…

  17. Factors determining long-term outcomes of hepatocellular carcinoma within the Milan criteria: liver transplantation versus locoregional therapy

    PubMed Central

    Kim, Jung Hee; Sinn, Dong Hyun; Gwak, Geum-Youn; Choi, Gyu-Seong; Kim, Jong Man; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Ki Yeon; Kim, Kyunga; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

    2016-01-01

    Abstract Patients with hepatocellular carcinoma (HCC) satisfying the Milan criteria are candidates for liver transplantation (LT), but locoregional therapies could be another options for them. A total of 1859 treatment-naïve HCC patients fulfilling the Milan criteria were analyzed. Survival tree analysis was performed to generate survival nodes with similar survival risks in 1729 non-LT group, and compared with the survival of 130 patients who received LT. Among patients who did not receive LT, survival tree analysis classified patients into 6 nodes according to Child-Pugh (CP) score, serum alphafetoprotein (AFP) levels, tumor size, and age, with different mortality risks (5-year survival rate of 87.3%, 77.5%, 65.8%, 64.7%, 44.0%, and 28.7% for nodes 1–6, respectively; P < 0.001). The overall survival of patients in nodes 1 (CP score 5 with AFP levels <5 ng/mL) and 2 (CP score 5 with maximal tumor size <2.5 cm) were comparable with that of patients who received LT (both P > 0.05), but the survival rates of patients in nodes 3 to 6 were worse than that of LT (P < 0.05 for all). In each survival node, survival differed slightly according to initial treatment modality for patients who did not receive LT. For patients who received LT, tumor stage at the time of LT was associated with long-term outcome. Certain groups of non-LT patients showed survival rates that were similar to the survival rates of LT patients. CP score, AFP levels, tumor size, and age were baseline factors that can help estimate the long-term outcomes of non-LT treatment. In addition, tumor stage at the time of LT and specific initial treatment modality in non-LT patients affected the long-term outcomes. These factors can help estimate the long-term outcomes of HCC patients diagnosed within the Milan criteria. PMID:27583916

  18. A Randomized Multicenter Trial to Compare Long-Term Functional Outcome, Quality of Life, and Complications of Surgical Procedures for Low Rectal Cancers

    PubMed Central

    Fazio, Victor W.; Zutshi, Massarat; Remzi, Feza H.; Parc, Yann; Ruppert, Reinhard; Fürst, Alois; Celebrezze, James; Galanduik, Susan; Orangio, Guy; Hyman, Neil; Bokey, Leslie; Tiret, Emmanuel; Kirchdorfer, Boris; Medich, David; Tietze, Marcus; Hull, Tracy; Hammel, Jeff

    2007-01-01

    Introduction: Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer. More recently coloplasty has been advocated as an alternative to a colonic pouch. However there have been no long-term randomized, controlled trials to compare functional outcomes of coloplasty, colonic J-Pouch (JP), or a straight anastomosis (SA) after the treatment of low rectal cancer. Aim: To compare the complications, long-term functional outcome, and quality of life (QOL) of patients undergoing a coloplasty, JP, or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer. Methods: A multicenter study enrolled patients with low rectal cancer, who were randomized intraoperatively to coloplasty (CP-1) or SA if JP was not feasible, or JP or coloplasty (CP-2) if a JP was feasible. Patients were followed for 24 months with SF-36 surveys to evaluate the QOL. Bowel function was measured quantitatively and using Fecal Incontinence Severity Index (FISI). Urinary function and sexual function were also assessed. Results: Three hundred sixty-four patients were randomized. All patients were evaluated for complications and recurrence. Mean age was 60 ±12 years, 71% were male. Twenty-three (7.4%) died within 24 months of surgery. No significant difference was observed in the complications among the 4 groups. Two hundred ninety-seven of 364 were evaluated for functional outcome at 24 months. There was no difference in bowel function between the CP-1 and SA groups. JP patients had fewer bowel movements, less clustering, used fewer pads and had a lower FISI than the CP-2 group. Other parameters were not statistically different. QOL scores at 24 months were similar for each of the 4 groups. Conclusions: In patients undergoing a restorative resection for low rectal cancer, a colonic JP offers significant advantages in function over an SA or a coloplasty. In patients who cannot have a pouch

  19. Mean platelet volume to platelet count ratio predicts in-hospital complications and long-term mortality in type A acute aortic dissection.

    PubMed

    Li, Dong-Ze; Chen, Qing-Jie; Sun, Hui-Ping; Zeng, Rui; Zeng, Zhi; Gao, Xiao-Ming; Ma, Yi-Tong; Yang, Yi-Ning

    2016-09-01

    Type A acute aortic dissection is a life-threatening vascular emergency because of its high morbidity and mortality. Platelet is a pivotal ingredient involved in the development of acute aortic dissection. In this study, we aimed to investigate whether mean platelet volume (MPV)/platelet count ratio predicts in-hospital complications and long-term mortality in type A acute aortic dissection. In this single-center and prospective cohort study, 106 consecutive patients with Stanford type A acute aortic dissection admitted to the hospital within 12 h after onset were recruited. The best cut-off value of MPV/platelet count ratio predicting all-cause mortality was determined by the receiver operator characteristic analysis. Patients were divided into high (H-MPV/platelet count) and low (L-MPV/platelet count) groups based on the cut-off value of 7.49 (10 fl/10/l). Patients were followed up for 3.5 years. Of the 106 acute aortic dissection patients, 71 (67.0%) died during the study period, with a median follow-up duration of 570 days. Compared to the L-MPV/platelet count group, patients with H-MPV/platelet count had a higher risk of in-hospital complications including hypotension, hypoxemia, myocardial ischemia/infarction, conscious disturbance, pericardial tamponade, paraplegia, and poor survival (all P < 0.05). In multivariable Cox regression models adjusted for potential confounders, MPV/platelet count ratio was positively associated with the hazard of all-cause mortality, irrespective of interventions either with medication only or urgent surgery, and the hazard ratios were 2.81 (95% confidence interval 1.28-4.48) for the H-MPV/platelet count group when taking L-MPV/platelet count group as the reference (P = 0.005). The MPV/platelet count ratio was a strong independent predictor for in-hospital complications and long-term mortality in patients with type A acute aortic dissection. PMID:26575495

  20. Factors Affecting Burnout when Caring for Older Adults Needing Long Term Care Services in Korea

    ERIC Educational Resources Information Center

    Won, Seojin; Song, Inuk

    2012-01-01

    The purpose of this study was to address factors related to caregiver burnout as a result of caring for an older adult with a chronic disease. Characteristics of care recipients and caregivers as well as social support were included to identify the relationships with caregiver burnout. The analysis was based on a sample of 334 older adults and…

  1. Risk Factors for Long-Term Homelessness: Findings From a Longitudinal Study of First-Time Homeless Single Adults

    PubMed Central

    Caton, Carol L. M.; Dominguez, Boanerges; Schanzer, Bella; Hasin, Deborah S.; Shrout, Patrick E.; Felix, Alan; McQuistion, Hunter; Opler, Lewis A.; Hsu, Eustace

    2005-01-01

    Objectives. We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002. Methods. Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed. Kaplan—Meier survival analysis and Cox regression were used to examine the association between baseline assessments and duration of homelessness. Results. Eighty-one percent of participants returned to community housing during the follow-up period; the median duration of homelessness was 190 days. Kaplan—Meier survival analysis showed that a shorter duration of homelessness was associated with younger age, current or recent employment, earned income, good coping skills, adequate family support, absence of a substance abuse treatment history, and absence of an arrest history. Cox regression showed that older age group P<.05) and arrest history (P<.01) were the strongest predictors of a longer duration of homelessness. Conclusions. Identification of risk factors for long-term homelessness can guide efforts to reduce lengths of stay in homeless shelters and to develop new preventive interventions. PMID:16131638

  2. The Preeminence of Early Life Trauma as a Risk Factor for Worsened Long-Term Health Outcomes in Women.

    PubMed

    Westfall, Nils C; Nemeroff, Charles B

    2015-11-01

    Early life trauma (ELT) comprises an array of disturbingly common distressing experiences between conception and the beginning of adulthood with numerous and significant potential long-term, even transgenerational, health consequences of great public health concern, including depression, cardiovascular disease, and other psychiatric and medical disorders, and neurobiological, psychological, and behavioral effects which are sufficiently robust to confound many types of biomedical research. The impact of ELT on a woman's health trajectory appears to vary with the specific characteristics of the ELT (e.g., type, number of different types, severity, and timing), the individual (e.g., age, genetics, epigenetics, personality, and cognitive factors), and the individual's environment (e.g., level of social support and ongoing stressors) and to be mediated to a significant extent by persistent changes in a number of biological systems, dysregulation of those governing the stress response chief among them. Growing knowledge of the risk factors and pathophysiological mechanisms by which ELT confers diathesis to various poor health outcomes and the unique treatment-response profiles of women with ELT will lead to much needed improvements in prevention, diagnostic, and therapeutic efforts, including more effective psychotherapy and pharmacotherapy approaches, hopefully making strides toward improvements in the lives of women everywhere and ending countless cycles of intergenerational trauma-associated pathology. This article attempts to broadly summarize the current state of knowledge about the long-term sequelae of ELT for women's health. PMID:26384339

  3. Epigenetic Studies Point to DNA Replication/Repair Genes as a Basis for the Heritable Nature of Long Term Complications in Diabetes

    PubMed Central

    Leontovich, Alexey A.; Intine, Robert V.; Sarras, Michael P.

    2016-01-01

    Metabolic memory (MM) is defined as the persistence of diabetic (DM) complications even after glycemic control is pharmacologically achieved. Using a zebrafish diabetic model that induces a MM state, we previously reported that, in this model, tissue dysfunction was of a heritable nature based on cell proliferation studies in limb tissue and this correlated with epigenetic DNA methylation changes that paralleled alterations in gene expression. In the current study, control, DM, and MM excised fin tissues were further analyzed by MeDIP sequencing and microarray techniques. Bioinformatics analysis of the data found that genes of the DNA replication/DNA metabolism process group (with upregulation of the apex1, mcm2, mcm4, orc3, lig1, and dnmt1 genes) were altered in the DM state and these molecular changes continued into MM. Interestingly, DNA methylation changes could be found as far as 6–13 kb upstream of the transcription start site for these genes suggesting potential higher levels of epigenetic control. In conclusion, DNA methylation changes in members of the DNA replication/repair process group best explain the heritable nature of cell proliferation impairment found in the zebrafish DM/MM model. These results are consistent with human diabetic epigenetic studies and provide one explanation for the persistence of long term tissue complications as seen in diabetes. PMID:26981540

  4. Epigenetic Studies Point to DNA Replication/Repair Genes as a Basis for the Heritable Nature of Long Term Complications in Diabetes.

    PubMed

    Leontovich, Alexey A; Intine, Robert V; Sarras, Michael P

    2016-01-01

    Metabolic memory (MM) is defined as the persistence of diabetic (DM) complications even after glycemic control is pharmacologically achieved. Using a zebrafish diabetic model that induces a MM state, we previously reported that, in this model, tissue dysfunction was of a heritable nature based on cell proliferation studies in limb tissue and this correlated with epigenetic DNA methylation changes that paralleled alterations in gene expression. In the current study, control, DM, and MM excised fin tissues were further analyzed by MeDIP sequencing and microarray techniques. Bioinformatics analysis of the data found that genes of the DNA replication/DNA metabolism process group (with upregulation of the apex1, mcm2, mcm4, orc3, lig1, and dnmt1 genes) were altered in the DM state and these molecular changes continued into MM. Interestingly, DNA methylation changes could be found as far as 6-13 kb upstream of the transcription start site for these genes suggesting potential higher levels of epigenetic control. In conclusion, DNA methylation changes in members of the DNA replication/repair process group best explain the heritable nature of cell proliferation impairment found in the zebrafish DM/MM model. These results are consistent with human diabetic epigenetic studies and provide one explanation for the persistence of long term tissue complications as seen in diabetes. PMID:26981540

  5. A factor controlling long-term variations of the Siberian water cycles during the past two centuries

    NASA Astrophysics Data System (ADS)

    Oshima, Kazuhiro; Ogata, Koto; Park, Hotaek; Tachibana, Yoshihiro

    2016-04-01

    Among all the rivers flowing into the Arctic Ocean, the three great Siberian rivers; Lena, Yenisei and Ob, are the three largest in terms of discharge (R), and are sources of freshwater, organic matter and heat into the ocean. While long-term variation and trend of the Rs have been examined in a lot of previous studies, causes of the R variations are still unclear. A previous study indicated the negative correlation between the Lena and Ob Rs during the 1980s to mid-1990s and it was affected by an east-west seesaw pattern of atmospheric circulation over Siberia. Our analysis indicated that 15-year running correlations between observed Rs of the Lena and Ob becomes weak after the mid-1990s and it was positive in mid-1950s to 1960s. The similar relationships were seen in precipitation (P) over the two basins. As in the observed Rs, more long-term record of reconstructed Rs of the Lena and Ob based on the tree-ring showed positive, negative and weak correlations in each of the epochs during the past two centuries. Interestingly, the correlations of the reconstructed Rs tend to be distributed on the negative side. These negative correlations were associated with the east-west seesaw pattern, as in the previous study. In addition, the correlations of Ps over eastern and western Siberia in an atmospheric general circulation model (AGCM) control simulation were distributed on more negative side compared to those in the CMIP3 multi-coupled models' simulations. The results of the AGCM and CMIP3 models reveal that the seesaw pattern frequently appears as an atmospheric internal variability over Siberia. Therefore, our results indicated that the east-west seesaw pattern as an atmospheric internal variability is a key factor controlling the long-term variation of water cycles in Siberia region.

  6. Multicultural long-term care nurses’ perceptions of factors influencing patient dignity at the end of life.

    PubMed

    Periyakoil, Vyjeyanthi S; Stevens, Marguerite; Kraemer, Helena

    2013-03-01

    The goal of this mixed-methods study was to characterize the perceptions of multicultural long-term care nurses about patient dignity at the end-of-life (EOL). The study was conducted in a large, urban, long-term care (LTC) facility. Participants were 45 long-term care nurses and 26 terminally ill nursing home residents. Nurses completed an openended interview about their perceptions of the concept of dying with dignity, and the data were analyzed using grounded theory methods. Main themes identified as promoting resident dignity at the EOL included treating them with respect, helping them prepare for the EOL, promoting shared decision-making, and providing high-quality care. The nurses’ cultural and religious backgrounds influenced their perceptions of what constitutes dignity-conserving care. Foreign-born nurses stressed the need for EOL rituals, but this was strikingly absent in the statements of U.S.-born nurses. Foreign-born Catholic nurses stated that the dying experience should not be altered using analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Nurses and terminally ill individuals completed the Dignity Card-sort Tool (DCT). A comparison of the DCT responses of the LTC nurses cohort with those of the terminally ill participants revealed that the nurses felt patient dignity was eroded when patient wishes were not followed and when they were treated without respect. In contrast, dying LTC residents felt that poor medical care and loss of ability to choose care options were the most important factors leading to erosion of dignity. PMID:23496266

  7. Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors

    PubMed Central

    Goo, Ae-Jin; Shin, Jinyoung; Ko, Hyeonyoung

    2016-01-01

    Background This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors. Methods A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire. Results We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81–14.02) was associated with the increased risk of depression. Conclusion These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation. PMID:27468341

  8. Biophysical and biological factors determining the ability to achieve long-term cryobiological preservation

    SciTech Connect

    Mazur, P.

    1997-12-01

    The BESTCapsule will maintain appropriate biological specimens for decades or centuries at cryogenic temperatures in the living state. Maintenance at temperatures below {approximately} {minus}140 C is not a problem. No ordinary chemical reactions in aqueous solutions can occur. The only source of damage will be the slow accumulation of physical damage to DNA from background ionizing radiation. But this source of damage should not become serious in less than a millennium. Rather, the main problem in cryopreservation is to devise procedures for cooling the biological specimens to {minus}196 C and returning them to normal temperatures without inflicting lethal injury. Regardless of the cell type, there are certain encompassing biophysical factors and constraints that determine whether they will survive or die during freezing and thawing. Superimposed on these may be special biological factors that apply to specific cell types. This paper will emphasize the former and give illustrative examples of the latter.

  9. Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study

    PubMed Central

    Atsushi, Ishibe; Mitsuyoshi, Ota; Kazuya, Yamaguchi; Syuhei, Kaida; Noriyuki, Kamiya; Masashi, Momiyama; Akira, Watanabe; Kentaro, Sekizawa; Nobuyuki, Kamimukai; Natsuko, Sugimasa; Jun, Watanabe; Yasushi, Ichikawa; Chikara, Kunisaki; Itaru, Endo

    2016-01-01

    AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer (CRC) at multiple Japanese institutions. METHODS: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group’s department of gastroenterological surgery. Among them, 234 patients with stage II/III disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic factors. RESULTS: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASA-PS (HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/dL (HR = 2.96, P = 0.007), T4 tumor (HR = 2.73, P = 0.002) and R1 resection (HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers (HR = 6.28, P = 0.009), a T4 tumor (HR = 3.46, P = 0.011) and R1 resection (HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive CRC. CONCLUSION: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC. PMID:27298566

  10. Estimation of road traffic emission factors from a long term tracer study

    NASA Astrophysics Data System (ADS)

    Belalcazar, Luis Carlos; Fuhrer, Oliver; Ho, Minh Dung; Zarate, Erika; Clappier, Alain

    2009-12-01

    Road traffic emissions, one of the largest source categories in megacity inventories, are highly uncertain. It is essential to develop methodologies to reduce these uncertainties to manage air quality more effectively. In this paper, we propose a methodology to estimate road traffic emission factors (EFs) from a tracer experiment and from roadside pollutants measurements. We emitted continuously during about 300 non-consecutive hours a passive tracer from a finite line source placed on one site of an urban street. At the same time, we measured continuously the resulting tracer concentrations at the other side of the street with a portable on-line gas chromatograph. We used n-propane contained in commercial liquid petroleum gas (LPG) as a passive tracer. Propane offers several advantages to traditional tracers (SF6, N2O, CFCs): low price, easily available, non-reactive, negligible global warming potential, and easy to detect with commercial on-line gas chromatographs. The tracer experiment was carried out from January to March 2007 in a busy street of Ho Chi Minh City (Vietnam). Traffic volume, weather information and pollutant concentrations were also measured at the measurement site. We used the results of the tracer experiment to calculate the dilution factors and afterwards we used these dilution factors, the traffic counts and the pollutant concentrations to estimate the EFs. The proposed method assumes that the finite emission line represents the emission produced by traffic in the full area of the street and therefore there is an error associated to this assumption. We use the Computational Fluids Dynamics (CFD) model MISKAM to calculate this error and to correct the HCMC EFs. EFs for 15 volatile organic compounds (VOCs) and NO are reported here. A comparison with available studies reveals that most of the EFs estimated here are within the range of EFs reported in other studies.

  11. Soil Microbial Community Responses to Long-Term Global Change Factors in a California Grassland

    NASA Astrophysics Data System (ADS)

    Qin, K.; Peay, K.

    2015-12-01

    Soil fungal and bacterial communities act as mediators of terrestrial carbon and nutrient cycling, and interact with the aboveground plant community as both pathogens and mutualists. However, these soil microbial communities are sensitive to changes in their environment. A better understanding of the response of soil microbial communities to global change may help to predict future soil microbial diversity, and assist in creating more comprehensive models of terrestrial carbon and nutrient cycles. This study examines the effects of four global change factors (increased temperature, increased variability in precipitation, nitrogen deposition, and CO2 enrichment) on soil microbial communities at the Jasper Ridge Global Change Experiment (JRGCE), a full-factorial global change manipulative experiment on three hectares of California grassland. While similar studies have examined the effects of global change on soil microbial communities, few have manipulated more factors or been longer in duration than the JRGCE, which began field treatments in 1998. We find that nitrogen deposition, CO2 enrichment, and increased variability in precipitation significantly affect the structure of both fungal and bacterial communities, and explain more of the variation in the community structures than do local soil chemistry or aboveground plant community. Fungal richness is correlated positively with soil nitrogen content and negatively with soil water content. Arbuscular mycorrhizal fungi (AMF), which associate closely with herbaceous plants' roots and assist in nutrient uptake, decrease in both richness and relative abundance in elevated CO2 treatments.

  12. Long Term Remission of Anorexia Nervosa: Factors Involved in the Outcome of Female Patients

    PubMed Central

    Espíndola, Cybele R.; Blay, Sergio L.

    2013-01-01

    Background Anorexia nervosa (AN) is usually marked by difficult recovery. Objective To elicit, describe and characterize factors involved in successful AN remission for at least five years and post-recovery life. Methods A qualitative study design using semi-structured interviews according to grounded theory methodology was used. An intentional sample of 15 information rich AN patients was selected using two sampling procedures: the criterion and “snowball” techniques. Qualitative interviews were audiotaped, transcribed, and entered into a content analysis. Researchers coded transcripts and developed themes. Results Four core parameters were found to be associated with remission: (i) ‘motivation to change/stimuli’; (ii) ‘empowerment/autonomy’; (iii) ‘media related factors’; (iv) ‘treatment factors’. Clinical remission can be associated with residual symptoms. Conclusions The recovery model involves not only one, but rather a set of inter-active variables, each one can partially explain remission. Media factors can take a new role on recovery. Remission, however, can be followed by remnants of the disease and functional limitations. PMID:23460796

  13. An exploration of factors affecting the long term psychological impact and deterioration of mental health in flooded households.

    PubMed

    Lamond, Jessica Elizabeth; Joseph, Rotimi D; Proverbs, David G

    2015-07-01

    The long term psychological effect of the distress and trauma caused by the memory of damage and losses associated with flooding of communities remains an under researched impact of flooding. This is particularly important for communities that are likely to be repeatedly flooded where levels of mental health disorder will damage long term resilience to future flooding. There are a variety of factors that affect the prevalence of mental health disorders in the aftermath of flooding including pre-existing mental health, socio-economic factors and flood severity. However previous research has tended to focus on the short term impacts immediately following the flood event and much less focus has been given to the longer terms effects of flooding. Understanding of factors affecting the longer term mental health outcomes for flooded households is critical in order to support communities in improving social resilience. Hence, the aim of this study was to explore the characteristics associated with psychological distress and mental health deterioration over the longer term. The research examined responses from a postal survey of households flooded during the 2007 flood event across England. Descriptive statistics, correlation analysis and binomial logistic regression were applied to data representing household characteristics, flood event characteristics and post-flood stressors and coping strategies. These factors were related to reported measures of stress, anxiety, depression and mental health deterioration. The results showed that household income, depth of flooding; having to move out during reinstatement and mitigating actions are related to the prevalence of psycho-social symptoms in previously flooded households. In particular relocation and household income were the most predictive factors. The practical implication of these findings for recovery after flooding are: to consider the preferences of households in terms of the need to move out during restorative

  14. Factors affecting burnout when caring for older adults needing long-term care services in Korea.

    PubMed

    Won, Seojin; Song, Inuk

    2012-01-01

    The purpose of this study was to address factors related to caregiver burnout as a result of caring for an older adult with a chronic disease. Characteristics of care recipients and caregivers as well as social support were included to identify the relationships with caregiver burnout. The analysis was based on a sample of 334 older adults and their caregivers in Korea. The logistic regression results indicated that the period of being in need of another's help among care-recipients, co-residence, caregivers' health condition, previous care experience, and caregivers' free time were correlated with the caregivers' future caregiving. Interestingly, the more experience caregivers had in caring for older adults, the more willing they were to provide care in the future. Thus, the discussion focuses on services for those who are new to providing care for older adults because they tend to have less coping skills. PMID:22696842

  15. Is a Long Term Work in Automotive Industry a Risk Factor for Renal Dysfunction?

    PubMed Central

    Assadi, Seyedeh Negar

    2015-01-01

    Background: Disorders of renal system can cause renal failure; therefore screening is necessary especially in workers who are exposed to harmful materials. Hypertension, diabetes mellitus, and hazardous exposures are non-occupational and occupational risk factors for renal diseases. Aim: The objective of this study was to determine the effects of working in automotive industry on renal function in Iran. Subjects and Methods: In a historical cohort study, workers of automotive industry who worked in production and had low exposure to metal fumes were selected and divided to three groups with 5–10, 11–20, and 21–30 years work duration. risk factors for renal diseases were collected and analyzed with SPSS using one-way ANOVA, correlation coefficient and with P < 0.05 and relative risk with a confidence interval (CI). Results: The means of work duration in Groups (A), (B) and (C) were 9.8 (0.6), 13.8 (2.0), 22.3 (1.6) years respectively with ANOVA (F) =187.864 and P < 0.01. Glomerular filtration rate (GFR) was 59.75 (0.70), 59.16 (1.52) and 59.10 (2.23) in Groups (A), (B), and (C) respectfully The relative risk of creatinine clearance, uric acid and mean blood pressure were the highest in Group (B); 1.970 - CI, 0.541–7.169, 1.571 95% CI: 0.198–12.470, and 1.519 95% CI: 0.425–5.426, but the differences were not significant. Conclusion: GFRs were decreased with work duration, but the differences were not significant. Working in automotive Industry with low exposure to toxic metals and solvents has no significant effect on GFR, creatinine clearance, uric acid, and mean blood pressure. PMID:25861528

  16. Thermophilic treatment of acidified and partially acidified wastewater using an anaerobic submerged MBR: Factors affecting long-term operational flux.

    PubMed

    Jeison, D; van Lier, J B

    2007-09-01

    The long-term operation of two thermophilic anaerobic submerged membrane bioreactors (AnSMBRs) was studied using acidified and partially acidified synthetic wastewaters. In both reactors, cake formation was identified as the key factor governing critical flux. Even though cake formation was observed to be mostly reversible, particle deposition proceeds fast once the critical flux is exceeded. Very little irreversible fouling was observed during long-term operation, irrespective of the substrate. Critical flux values at the end of the reactors operation were 7 and 3L/m(2)h for the AnSMBRs fed with acidified and partially acidified wastewaters, respectively, at a gas superficial velocity of 70m/h. Small particle size was identified as the responsible parameter for the low observed critical flux values. The degree of wastewater acidification significantly affected the physical properties of the sludge, determining the attainable flux. Based on the fluxes observed in this research, the membrane costs would be in the range of 0.5euro/m(3) of treated wastewater. Gas sparging was ineffective in increasing the critical flux values. However, preliminary tests showed that cross-flow operation may be a feasible alternative to reduce particle deposition. PMID:17644148

  17. Long-term evaluation of granulocyte-colony stimulating factor on hypoxic-ischemic brain damage in infant rats

    PubMed Central

    Fathali, Nancy; Lekic, Tim; Zhang, John H.

    2011-01-01

    Purpose Hypoxia-ischemia (HI), as a major cause of fetal brain damage, has long-lasting neurological implications. Therefore, therapeutic interventions that attenuate the neuropathological outcome of HI while also improving the neuro-functional outcome are of paramount clinical importance. The aim of this study was to investigate the long-term functional and protective actions of granulocyte-colony stimulating factor (G-CSF) treatment in an experimental model of cerebral HI. Methods Postnatal day-7 Sprague-Dawley rats were subjected to HI surgery, which entailed ligation of the right common carotid artery followed by 2 h of hypoxia (8% O2). Treatment consisted of subcutaneous injection of G-CSF at 1 h after hypoxia followed by an additional one injection per day for 5 days (6 total injections) or for 10 days (11 total injections). Animals were euthanized 5 weeks post-insult for extensive evaluation of neurological deficits and assessment of brain, spleen, heart, and liver damage. Results G-CSF treatment promoted somatic growth and prevented brain atrophy and under-development of the heart. Moreover, reflexes, limb placing, muscle strength, motor coordination, short-term memory, and exploratory behavior were all significantly improved by both G-CSF dosing regimens. Conclusions Long-term neuroprotection afforded by G-CSF in both morphological and functional parameters after a hypoxic-ischemic event in the neonate provides a rationale for exploring clinical translation. PMID:20461500

  18. Interplay of Psychosocial Factors and the Long-Term Course of Adolescents with a Substance Use Disorder

    PubMed Central

    Winters, Ken C.; Stinchfield, Randy D.; Lee, Susanne; Latimer, William W.

    2009-01-01

    This paper examines the association of psychosocial factors and long-term drug use behaviors (year-5.5) among adolescents with a substance dependence disorder. One group received treatment with a 12-Step approach (n = 159) and one group was on a waiting list (n = 62). Four psychosocial factors (deviant behavior, peer drug environment, psychological disturbance and family estrangement), as measured by a standardized self-report questionnaire, were examined as predictors across three time points (year-1, year-4 and year-5.5). Improved outcome across time was significantly associated with decreases in deviant behavior, peer drug environment and family estrangement. However, psychological disturbance was not associated with outcome. Also, we did not find an effect on outcome as a function of age, gender and race. Youth that received treatment, as opposed to the waiting list youth, generally revealed a more favorable outcome across time. Treatment implications of the study findings are discussed. PMID:19042330

  19. Risk factors for long-term mental and psychosomatic distress in Latvian Chernobyl liquidators.

    PubMed Central

    Viel, J F; Curbakova, E; Dzerve, B; Eglite, M; Zvagule, T; Vincent, C

    1997-01-01

    Epidemiologic studies on the health effects of the Chernobyl disaster have focused largely on physical health, whereas the psychological consequences have received little attention. The authors have assessed the associations of various exposure variables with mental and psychosomatic distress in a sample of 1412 Latvian liquidators drawn from the State Latvian Chernobyl Clean-up Workers Registry. The outcome was a mixed mental-psychosomatic disorder occurring during 1986 to 1995. Comparisons among subgroups of the cohort classified according to exposure type or level were based on the proportional hazards model. Length of work (> or = 28 days) in a 10-km radius from the reactor (relative risk [RR] = 1.39, 95% confidence interval [CI] 1.14-1.70), work (> 1 time) on the damaged reactor roof (RR = 1.46, 95% CI 1.02-2.09), forest work (RR = 1.41, 95% CI 1.19-1.68), fresh fruit consumption (> or = 1 time/day) (RR = 1.72, 95% CI 1.12-2.65) are risk factors for mixed mental-psychosomatic disorder. Construction of the sarcophagus (RR = 1.82, 95% CI 0.89-3.72) is also associated with this outcome, although nonsignificantly. Distinguishing stress-related from radiation-induced effects in this data set was difficult and these findings should provide a basis for later hypothesis testing in other cohorts. PMID:9467079

  20. Long-term Outcomes of Percutaneous Venoplasty and Gianturco Stent Placement to Treat Obstruction of the Inferior Vena Cava Complicating Liver Transplantation

    SciTech Connect

    Lorenz, Jonathan M. Beek, Darren van; Funaki, Brian; Ha, Thuong G. Van; Zangan, Stephen; Navuluri, Rakesh; Leef, Jeffery A.

    2013-05-11

    PurposeEvaluation of long-term outcomes of venoplasty and Gianturco stents to treat inferior vena cava (IVC) obstruction after liver transplantation.MethodsWe retrospectively analyzed records from 33 consecutive adult patients referred with the intent to treat suspected IVC obstruction after liver transplantation. Treatment was performed for occlusion or stenosis with a gradient exceeding 3 mmHg. The primary treatment was venoplasty and, if refractory, Gianturco stent placement. Recurrence prompted repeat venoplasty or stent placement.ResultsOf the 33 patients, 25 (aged 46.9 ± 12.2 years) required treatment at a mean of 2.3 years (14 days to 20.3 years) after transplantation. For technically successful cases, primary treatment was venoplasty alone (14) or with stent placement (10). Technical success was 96 % (24 of 25) reflecting failure to cross one occlusion. Clinical success was 88 % (22 of 25) reflecting the technical failure and two that died of unrelated complications within 5 weeks. Cumulative primary patencies were 57.1 % at 6 months (n = 21) and 51.4 % at 1 (n = 10), 3 (n = 7), 5 (n = 6), and 7 (n = 5) years. Cumulative primary assisted patency was 95.2 % at 6 months (n = 21) and at 1 (n = 15), 3 (n = 9), 5 (n = 8), and 7 (n = 8) years. The 17 patients stented for refractory (n = 10) or recurrent (n = 7) stenosis had cumulative primary and primary assisted patencies of 86.0 and 100 %, respectively, from 6 months (n = 14) to 7 years (n = 3). No major complications occurred; one fractured stent was observed after 11.6 years.ConclusionFor IVC obstruction following liver transplantation, excellent long-term outcomes can be achieved by venoplasty and Gianturco stent placement.

  1. Effects of transforming growth factor-beta on long-term human cord blood monocyte cultures

    SciTech Connect

    Orcel, P.; Bielakoff, J.; De Vernejoul, M.C. )

    1990-02-01

    Transforming growth factor-beta (TGF-beta) modulates growth and differentiation in many cell types and is abundant in bone matrix. We recently showed that human cord blood monocytes cultured in the presence of 1,25(OH)2D3 acquire some features of osteoclast precursors. Since TGF-beta has been shown to influence bone resorption in organ culture, we have studied the effect of TGF-beta (1-1,000 pg/ml) on cord blood monocyte cultures. These cells were cultured on plastic substrate during 3 weeks in the presence of 20% horse serum and 10(-9) M 1,25(OH)2D3. TGF-beta, from a concentration of 10 pg/ml in the culture medium, decreased in a dose dependent manner the formation of multinucleated cells. At a concentration of TGF-beta of 1 ng/ml, the multinucleated cells were reduced to 2.1% +/- 0.3%, compared to 19.3% +/- 1.5% in control cultures. TGF-beta inhibited in a dose-dependent manner the proliferation of cord blood monocytes as assessed by 3H-thymidine incorporation at 7 and 14 days of culture. The fusion index was also decreased by 3 weeks of treatment with TGF-beta. Indomethacin did not reverse the inhibitory effects of TGF-beta. The expression of the osteoclastic phenotype was assessed using two different antibodies: 23C6, a monoclonal antibody directed against the vitronectin receptor, which is highly expressed by osteoclasts but not by adult monocytes, and an antibody to HLA-DR, which is not present on osteoclast. TGF-beta decreased the expression of HLA-DR and increased in a dose-dependent manner the proportion of 23C6-labeled cells; these results suggest that TGF-beta could modulate a differentiation effect to the osteoclastic phenotype. However, when cord blood monocytes were cultured on devitalized rat calvariae prelabeled with 45Ca, TGF-beta did not induce any 45Ca release from bone cultured with monocytes.

  2. Long-Term Care

    MedlinePlus

    ... this page please turn Javascript on. Long-Term Care What Is Long-Term Care? Long-term care involves a variety of services ... the Escape (Esc) button on your keyboard.) Most Care Provided at Home Long-term care is provided ...

  3. Air pollution and blood lipid markers levels: Estimating short and long-term effects on elderly hypertension inpatients complicated with or without type 2 diabetes.

    PubMed

    Xiao, Sanhua; Liu, Ranran; Wei, Youxiu; Feng, Lin; Lv, Xuemin; Tang, Fei

    2016-08-01

    With the development of society and the economy, many Chinese cities are shrouded in pollution haze for much of the year. Scientific studies have identified various adverse effects of air pollutants on human beings. However, the relationships between air pollution and blood lipid levels are still unclear. The objective of this study is to explore the short and long-term effects of air pollution on eight blood lipid markers among elderly hypertension inpatients complicated with or without type 2 diabetes (T2D). Blood lipid markers which met the pre-established inclusion criteria were exported from the medical record system. Air pollution data were acquired from the official environmental protection website. Associations between the air quality index and the blood lipid indexes were analyzed by one-way ANOVA and further Bonferroni correction. In an exposure time of 7 days or longer, blood lipid markers were somewhat affected by poor air quality. However, the results could not predict whether atherosclerosis would be promoted or inhibited by poorer air condition. Changes of blood lipid markers of hypertension inpatients with or without T2D were not completely the same, but no blood lipid markers had an opposite trend between the two populations. The air quality index was associated with changes to blood lipid markers to some extent in a population of hypertension inpatients with or without T2D. Further studies are needed to investigate the potential mechanism by which air pollutants induce blood lipids changes. PMID:27180144

  4. Factors Associated With Long-Term Weight Loss Following Bariatric Surgery Using 2 Methods for Repeated Measures Analysis.

    PubMed

    Baldridge, Abigail S; Pacheco, Jennifer A; Aufox, Sharon A; Kim, Kwang-Youn A; Silverstein, J C; Denham, W; Hungness, E; Smith, Maureen E; Allen, Norrina B; Greenland, Philip; Rasmussen-Torvik, Laura J

    2015-08-01

    We used electronic health record data from 162 patients enrolled in the NUgene Project (2002-2013) to determine demographic factors associated with long-term (from 1 to up to 9.5 (mean = 5.6) years) weight loss following Roux-en-Y gastric bypass surgery. Ninety-nine (61.1%) patients self-reported white, and 63 (38.9%) self-reported black, mixed, or missing race. The average percent weight loss was -33.4% (standard deviation, 9.3) at 1 year after surgery and -30.7% (standard deviation, 12.5) at the last follow-up point. We used linear mixed and semiparametric trajectory models to test the association of surgical and demographic factors (height, surgery age, surgery weight, surgery body mass index, marital status, sex, educational level, site, International Classification of Diseases code, Current Procedural Terminology code, Hispanic ethnicity, and self-reported race) with long-term percent weight loss and pattern of weight loss. We found that black, mixed, and missing races (combined) in comparison with white race were associated with a decreased percent weight loss of -4.31% (95% confidence interval: -7.30, -1.32) and were less likely to have higher and sustained percent weight loss (P = 0.04). We also found that less obese patients were less likely to have higher and sustained percent weight loss (P = 0.01). These findings may be helpful to patients in setting expectations after weight loss surgery. PMID:26093003

  5. A novel approach for long-term determination of indoor 222Rn progeny equilibrium factor using nuclear track detectors

    NASA Astrophysics Data System (ADS)

    Amgarou, K.; Font, Ll.; Baixeras, C.

    2003-06-01

    A detailed study of the measurement principles of airborne 222Rn decay products by means of nuclear track detectors (NTDs), taking into account the range of variation of the parameters influencing their concentration indoors, has shown that it is not possible for the existing methods to obtain the associated long-term equilibrium factor with an appropriate accuracy. For this reason, we have established a novel approach based on the new concept of reduced equilibrium factor, which can be obtained from the only measurement of airborne 222Rn and its α-emitter daughter ( 218Po and 214Po) concentrations using a passive, integrating and multi-component system of NTDs. We have found that the equilibrium factor has a linear dependence on the reduced equilibrium factor regardless the values taken for the rates of ventilation, of aerosol attachment and of surface deposition. By using well-controlled exposures in a reference laboratory, we have shown that the equilibrium factor values determined with our system agree with those obtained by active monitors. Finally, as a pilot test, several dosimeters were exposed in an inhabited Swedish single-family house. The results of this exposure suggest the usefulness of this method to perform routine surveys in private homes and in workplaces in order to estimate the annual effective dose received by the general public and the workers due to the presence of 222Rn daughters.

  6. Caries prevalence, caries-related factors and plaque pH in adolescents with long-term asthma.

    PubMed

    Stensson, M; Wendt, L-K; Koch, G; Oldaeus, G; Lingström, P; Birkhed, D

    2010-01-01

    The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had 'a high chance of avoiding caries' compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma. PMID:21051892

  7. Long-Term Effects of Autologous Bone Marrow Stem Cell Treatment in Acute Myocardial Infarction: Factors That May Influence Outcomes

    PubMed Central

    Clifford, David M.; Fisher, Sheila A.; Brunskill, Susan J.; Doree, Carolyn; Mathur, Anthony; Clarke, Mike J.; Watt, Suzanne M.; Martin-Rendon, Enca

    2012-01-01

    Aims To investigate whether there are important sources of heterogeneity between the findings of different clinical trials which administer autologous stem cell treatment for acute myocardial infarction (AMI) and to evaluate what factors may influence the long-term effects of this treatment. Methods and Results MEDLINE (1950-January 2011), EMBASE (1974-January 2011), CENTRAL (The Cochrane Library 2011, Issue 1), CINAHL (1982-January 2011), and ongoing trials registers were searched for randomised trials of bone marrow stem cells as treatment for AMI. Hand-searching was used to screen recent, relevant conference proceedings (2005–2010/11). Meta-analyses were conducted using random-effects models and heterogeneity between subgroups was assessed using chi-squared tests. Planned analyses included length of follow-up, timing of cell infusion and dose, patient selection, small trial size effect, methodological quality, loss of follow-up and date of publication. Thirty-three trials with a total of 1,765 participants were included. There was no evidence of bias due to publication or time-lag, methodological quality of included studies, participant drop-out, duration of follow-up or date of the first disclosure of results. However, in long-term follow-ups the treatment seemed more effective when administered at doses greater than 108 cells and to patients with more severe heart dysfunction. Conclusions Evaluation of heterogeneity between trials has not identified significant sources of bias in this study. However, clinical differences between trials are likely to exist which should be considered when undertaking future trials. PMID:22655042

  8. What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals

    PubMed Central

    Edwards, Susan; Stanners, Melinda; Shakib, Sepehr; Bell, J Simon

    2016-01-01

    Objectives Polypharmacy and multimorbidity are common in long-term care facilities (LTCFs). Reducing polypharmacy may reduce adverse events and maintain quality of life. Deprescribing refers to reducing medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The objective was to use nominal group technique (NGT) to generate then rank factors that general medical practitioners (GPs), nurses, pharmacists and residents or their representatives perceive are most important when deciding whether or not to deprescribe medications. Design Qualitative research using NGT. Setting Participants were invited if they worked with, or resided in LTCFs across metropolitan and regional South Australia. Participants 11 residents/representatives, 19 GPs, 12 nurses and 14 pharmacists participated across six separate groups. Methods Individual groups of GPs, nurses, pharmacists and residents/representatives were convened. Using NGT each group ranked factors perceived to be most important when deciding whether or not to deprescribe. Then, using NGT, the prioritised factors from individual groups were discussed and prioritised by a multidisciplinary metropolitan and regional group comprised of resident representatives, GPs, nurses and pharmacists. Results No two groups had the same priorities. GPs ranked ‘evidence for deprescribing’ and ‘communication with family/resident’ as most important factors. Nurses ranked ‘GP receptivity to deprescribing’ and ‘nurses ability to advocate for residents’ as most important. Pharmacists ranked ‘clinical appropriateness of therapy’ and ‘identifying residents’ goals of care’ as most important. Residents ranked ‘wellbeing of the resident’ and ‘continuity of nursing staff’ as most important. The multidisciplinary groups ranked ‘adequacy of medical and medication history’ and ‘identifying residents’ goals of care’ as most important. Conclusions While each group prioritised

  9. The Role of Gender in Factors Associated With Addiction Treatment Satisfaction Among Long-Term Opioid Users

    PubMed Central

    Marchand, Kirsten; Palis, Heather; Peng, Defen; Fikowski, Jill; Harrison, Scott; Spittal, Patricia; Schechter, Martin T.; Oviedo-Joekes, Eugenia

    2015-01-01

    Objectives: To identify factors associated with Opioid Agonist Treatment (OAT) satisfaction and to determine whether these relationships are gender specific. Methods: This study was based on data collected in a cross-sectional study among long-term opioid-dependent individuals (n = 160; 46.3% women). Participants completed the Client Satisfaction Questionnaire in reference to OAT episodes. Sociodemographic, illicit substance use, health, and addiction treatment history data were collected. Multivariable linear regression was used to determine the relationship between these variables and treatment satisfaction. To explore the potential role of gender in these identified relationships stratified multivariable models were tested. Additional open-ended questions regarding positive and negative perceptions of treatment were collected, and a thematic analysis was conducted. Results: In the multivariable linear regression model, participants who were older, of Aboriginal ancestry, and currently receiving OAT had higher OAT satisfaction scores, whereas participants who had methadone dose preferences of 30 mg or less had lower OAT satisfaction. In stratified analyses among women, the relationship between preferred methadone dose and current OAT remained significantly associated with satisfaction. Open-ended positive and negative perceptions complemented and provided further valuable data to interpret these identified relationships. Conclusions: To our knowledge, this is the first study to explore the potential role of gender in factors associated with OAT satisfaction. These findings provide valuable information to health care providers working in OAT settings regarding how to address women and men's OAT needs and improve treatment satisfaction. PMID:26335006

  10. Prevalence and risk factors for intestinal protozoa infection in elderly residents at Long Term Residency Institutions in Southeastern Brazil.

    PubMed

    Girotto, Katymilla Guimarães; Grama, Daliane Faria; da Cunha, Maria Júlia Rodrigues; Faria, Elaine Silva Marques; Limongi, Jean Ezequiel; Pinto, Rogério de Melo Costa; Cury, Márcia Cristina

    2013-01-01

    This study determined the prevalence of intestinal protozoa in Long Term Residency Institutions for the Elderly (ILPI) in elders, nurses and food handlers, identifying the risk factors associated with the infections. Stool samples taken from the elderly (n = 293), nurses (63) and food handlers (19) were studied. Questionnaires were used with questions related to sociodemographic variables, health, behavior and health characteristics. Stool samples were examined using the techniques of Faust and Ziehl Neelsen, and the prevalence of G. duodenalis, Cryptosporidium spp., E. histolytica/dispar in the elderly was 4.0%, 1.0% and 0.3% respectively. Nurses and food handlers showed 4.8% and 5.2% positivity only for G. duodenalis, respectively. The origin of the individuals and contact with domestic animals has been associated with infection by G. duodenalis in the elderly, and contact with domestic animals was considered a risk factor for infection. The last stool examinations were related to Cryptosporidium spp.. None of the variables were associated with E. histolytica/dispar. The frequency of hand washing was significantly associated with G. duodenalis among nurses. The frequency of positive samples of G. duodenalis, Cryptosporidium spp., E. histolytica/dispar showed that ILPIs environments are conducive to this occurring due to contact between the elderly, nurses and food handlers, which are often poorly trained in hygiene procedures and food handling. PMID:23328721

  11. Transforming growth factor β recruits persistent MAPK signaling to regulate long-term memory consolidation in Aplysia californica.

    PubMed

    Shobe, Justin; Philips, Gary T; Carew, Thomas J

    2016-05-01

    In this study, we explore the mechanistic relationship between growth factor signaling and kinase activity that supports the protein synthesis-dependent phase of long-term memory (LTM) consolidation for sensitization ofAplysia Specifically, we examine LTM for tail shock-induced sensitization of the tail-elicited siphon withdrawal (T-SW) reflex, a form of memory that requires both (i) extracellular signal-regulated kinase (ERK1/2; MAPK) activity within identified sensory neurons (SNs) that mediate the T-SW and (ii) the activation of transforming growth factor β (TGFβ) signaling. We now report that repeated tail shocks that induce intermediate-term (ITM) and LTM for sensitization, also induce a sustained post-training phase of MAPK activity in SNs (lasting at least 1 h). We identified two mechanistically distinct phases of post-training MAPK: (i) an immediate phase that does not require ongoing protein synthesis or TGFβ signaling, and (ii) a sustained phase that requires both protein synthesis and extracellular TGFβ signaling. We find that LTM consolidation requires sustained MAPK, and is disrupted by inhibitors of protein synthesis and TGFβ signaling during the consolidation window. These results provide strong evidence that TGFβ signaling sustains MAPK activity as an essential mechanistic step for LTM consolidation. PMID:27084925

  12. Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients

    PubMed Central

    Tawada, Mitsuhiro; Ito, Yasuhiko; Hamada, Chieko; Honda, Kazuho; Mizuno, Masashi; Suzuki, Yasuhiro; Sakata, Fumiko; Terabayashi, Takeshi; Matsukawa, Yoshihisa; Maruyama, Shoichi; Imai, Enyu; Matsuo, Seiichi; Takei, Yoshifumi

    2016-01-01

    Background and Objectives Encapsulating peritoneal sclerosis (EPS) is a rare but serious and life-threatening complication of peritoneal dialysis (PD). However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established. Methods Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis. Results According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045), new membrane formation score (P = 0.006), ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001), presence of CD31-negative vessels (P = 0.021), fibrin deposition (P<0.001), and collagen volume fraction (P = 0.018) were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR) 0.44, P = 0.003) and fibrin deposition (OR 6.35, P = 0.027) as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation. Conclusions These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis. PMID:27119341

  13. Influenza in long-term care facilities: preventable, detectable, treatable.

    PubMed

    Mossad, Sherif B

    2009-09-01

    Influenza in long-term care facilities is an ever more challenging problem. Vaccination of residents and health care workers is the most important preventive measure. Although vaccine efficacy has been questioned, the preponderance of data favors vaccination. Antiviral resistance complicates postexposure chemoprophylaxis and treatment. Factors that limit the choice of antiviral agents in this patient population include limited vaccine supplies and impaired dexterity and confusion in long-term care residents. PMID:19726556

  14. Long-term culture and differentiation of CNS precursors derived from anterior human neural rosettes following exposure to ventralizing factors

    SciTech Connect

    Colleoni, Silvia; Giannelli, Serena G.; Armentero, Marie-Therese; Blandini, Fabio; Broccoli, Vania; Lazzari, Giovanna

    2010-04-15

    In this study we demonstrated that neural rosettes derived from human ES cells can give rise either to neural crest precursors, following expansion in presence of bFGF and EGF, or to dopaminergic precursors after exposure to ventralizing factors Shh and FGF8. Both regionalised precursors are capable of extensive proliferation and differentiation towards the corresponding terminally differentiated cell types. In particular, peripheral neurons, cartilage, bone, smooth muscle cells and also pigmented cells were obtained from neural crest precursors while tyrosine hydroxylase and Nurr1 positive dopaminergic neurons were derived from FGF8 and Shh primed rosette cells. Gene expression and immunocytochemistry analyses confirmed the expression of dorsal and neural crest genes such as Sox10, Slug, p75, FoxD3, Pax7 in neural precursors from bFGF-EGF exposed rosettes. By contrast, priming of rosettes with FGF8 and Shh induced the expression of dopaminergic markers Engrailed1, Pax2, Pitx3, floor plate marker FoxA2 and radial glia markers Blbp and Glast, the latter in agreement with the origin of dopaminergic precursors from floor plate radial glia. Moreover, in vivo transplant of proliferating Shh/FGF8 primed precursors in parkinsonian rats demonstrated engraftment and terminal dopaminergic differentiation. In conclusion, we demonstrated the derivation of long-term self-renewing precursors of selected regional identity as potential cell reservoirs for cell therapy applications, such as CNS degenerative diseases, or for the development of toxicological tests.

  15. Impact factors on the long-term sustainability of Borehole Heat Exchanger coupled Ground Source Heat Pump System

    NASA Astrophysics Data System (ADS)

    Shao, Haibing; Hein, Philipp; Görke, Uwe-Jens; Bucher, Anke; Kolditz, Olaf

    2016-04-01

    In recent years, Ground Source Heat Pump System (GSHPS) has been recognized as an efficient technology to utilize shallow geothermal energy. Along with its wide application, some GSHPS are experiencing a gradual decrease in Borehole Heat Exchanger (BHE) outflow temperatures and thus have to be turned off after couple of years' operation. A comprehensive numerical investigation was then performed to model the flow and heat transport processes in and around the BHE, together with the dynamic change of heat pump efficiency. The model parameters were based on the soil temperature and surface weather condition in the Leipzig area. Different scenarios were modelled for a service life of 30 years, to reveal the evolution of BHE outflow and surrounding soil temperatures. It is found that lateral groundwater flow and using BHE for cooling will be beneficial to the energy recovery, along with the efficiency improvement of the heat pump. In comparison to other factors, the soil heat capacity and thermal conductivity are considered to have minor impact on the long-term sustainability of the system. Furthermore, the application of thermally enhanced grout material will improve the sustainability and efficiency. In contrast, it is very likely that undersized systems and improper grouting are the causes of strong system degradation.

  16. Platelet-activating factor attenuation of long-term potentiation in rat hippocampal slices via protein tyrosine kinase signaling.

    PubMed

    Reiner, Benjamin; Wang, Wenwei; Liu, Jianuo; Xiong, Huangui

    2016-02-26

    It is well established that HIV-1-infected mononuclear phagocytes release platelet activating factor (PAF) and elevated levels of PAF have been detected in blood and in the cerebrospinal fluid (CSF) of acquired immunodeficiency syndrome (AIDS) patients with HIV-associated neurocognitive disorders (HAND). It is our hypothesis that the elevated levels of PAF alter long-term potentiation (LTP) in the hippocampus, leading to neurocognitive dysfunction. To test this hypothesis, we studied the effects of PAF on LTP in the CA1 region of rat hippocampal slices. Our results showed incubation of hippocampal slices with PAF attenuated LTP. The PAF-mediated attenuation was blocked by ginkgolide B, a PAF receptor antagonist, suggesting PAF attenuation of LTP via PAF receptors. Application of lyso-PAF, an inactive PAF analog, had no apparent effect on LTP. Further investigation revealed an involvement of tyrosine kinase in PAF attenuation of LTP, which was demonstrated by lavendustin A (a specific protein tyrosine kinase inhibitor) blockage of PAF attenuation of LTP. As LTP is widely considered as the cellular and synaptic basis for learning and memory, the attenuation of LTP by PAF may contribute at least in part to the HAND pathogenesis. PMID:26808643

  17. The relationship of quantitative epidermal growth factor receptor expression in non-small cell lung cancer to long term survival.

    PubMed Central

    Veale, D.; Kerr, N.; Gibson, G. J.; Kelly, P. J.; Harris, A. L.

    1993-01-01

    Increased expression of epidermal growth factor receptor (EGFr) has been reported in non small cell lung cancers (NSCLC) when compared to normal lung. We have examined post-operative survival in 19 surgically treated patients with NSCLC who had full characterisation of EGFr on primary tumour membrane preparations from resection specimens. There were ten squamous, seven adeno and two large cell carcinomas. The median concentration of high affinity sites was 31 fmol per mg of protein (4-1532) and the median dissociation constant (Kd) of these high affinity sites was 2.3 x 10(-10) per mol (1.2-30 x 10(-10)). Seven patients survived over 5 years. Twelve patients died between 8.5 and 55 months from the time of surgery. When > 5 year survivors were compared to non-survivors there was no difference as regards tumour size or stage, or as regards age or sex. The survivors had a median concentration of high affinity EGFr sites of 16.1 fmol mg-1 protein compared to a median concentration of 68.6 fmol mg-1 protein in the non-survivors (P = 0.01 Wilcoxon test). No long term survivor had > 35 fmol mg-1 protein of receptor. Thus EGFr quantitation may give independent prognostic information in NSCLC and help to select patients for adjuvant therapy after surgery. These results need confirmation in a larger prospective study. PMID:8391303

  18. Controlling Factors of Long-Term Trends in Mercury Wet Deposition and Precipitation Concentrations at Huntington Wildlife Forest

    NASA Astrophysics Data System (ADS)

    Ye, Z.; Mao, H.; Driscoll, C. T.

    2015-12-01

    Observations from the Mercury Deposition Network (MDN) at Huntington Wildlife Forest (HWF) suggested that a significant decline (r2 = 0.34, p = 0.03) from 2000 to 2013 in volume weighted mean (VWM) Hg concentrations in precipitation was linked to Hg emission decreases in the United States, especially in the Northeast and Midwest, and yet Hg wet deposition has remained fairly constant over the past two decades. The present study aimed to investigate the climatic, terrestrial, and anthropogenic factors that influenced the decadal pattern in Hg wet deposition in upstate NY. In spring and summer, when Hg wet deposition was the strongest, significant positive correlation (r2 = 0.89, p < 0.0001 in spring; r2 = 0.58, p = 0.002 in summer) of Hg wet deposition with precipitation was found. Increases in precipitation during these seasons could offset the decreasing of Hg concentration in precipitation. Besides, springtime positive correlation (r2 = 0.35, p = 0.02) between precipitation and the North Atlantic Oscillation (NAO) index together with geopotential height and wind speed analysis indicated that large-scale dynamical forcing was likely an important factor influencing the long term trend in springtime Hg wet deposition at HWF. To further quantify the roles of meteorological and anthropogenic factors in Hg wet deposition, the Community Multiscale Air Quality (CMAQ) model was employed using an algorithm depicting state-of-the-art Hg chemistry mechanism and up-to-date Hg emission inventories evaluated with MDN and Atmospheric Mercury Network (AMNet) measurement data. CMAQ simulations with a constant vs. realistic meteorological conditions for multiple warm seasons (including spring and summer) were used to characterize and quantify the impacts of inter-annual variability of precipitation and atmospheric circulation on Hg wet deposition. In addition, contributions to Hg wet deposition from decreases in anthropogenic emissions in NYS and nation-wide were quantified from

  19. Correlation between vascular endothelial growth factor and long-term prognosis in patients with acute myocardial infarction

    PubMed Central

    NIU, JIAMIN; HAN, XIA; QI, HUAXIN; YIN, JIE; ZHANG, ZHIQIANG; ZHANG, ZENGTANG

    2016-01-01

    The aim of the present study was to investigate the correlation between plasma the levels of vascular endothelial growth factor (VEGF) and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). A total of 124 patients with AMI undergoing emergency percutaneous coronary intervention (PCI) were selected, and plasma VEGF levels were measured 7 days after the onset of AMI using an enzyme-linked immunosorbent assay. The patients were divided into the L (≤190 pg/ml VEGF) and H (>190 pg/ml VEGF) groups, and were followed up every 2 months for an average of 12 months. MACE were recorded during follow-up. On the basis of these results, the patients were further divided into the MACE and non-MACE (N-MACE) groups, and the serum VEGF concentration was compared between the two groups. At the 6-month follow-up, the incidence of MACE in the H group was found to be significantly reduced compared with the L group. The serum VEGF concentration in the N-MACE group was significantly higher compared with the MACE group. Multinomial logistic regression revealed that reduced VEGF levels (β=1.243; 95% CI, 1.018–1.326; P=0.026) were independent risk factors for MACE. In conclusion, high plasma VEGF levels at 7 days after AMI onset facilitate the long-term prognosis in the same infarct zone in patients with AMI, while low plasma VEGF levels are independent risk factors for MACE. PMID:27347081

  20. Predictive Factors for Acute and Late Urinary Toxicity After Permanent Prostate Brachytherapy: Long-Term Outcome in 712 Consecutive Patients

    SciTech Connect

    Keyes, Mira Miller, Stacy; Moravan, Veronika; Pickles, Tom; McKenzie, Michael; Pai, Howard; Liu, Mitchell; Kwan, Winkle; Agranovich, Alexander; Spadinger, Ingrid; Lapointe, Vincent; Halperin, Ross; Morris, W. James

    2009-03-15

    Purpose: To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity. Results: The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02). Conclusion: Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low

  1. [Surgery and invasive procedures in patients on long-term treatment with oral direct thrombin or factor Xa inhibitors].

    PubMed

    Sié, P; Samama, C-M; Godier, A; Rosencher, N; Steib, A; Llau, J-V; van der Linden, P; Pernod, G; Lecompte, T; Gouin-Thibault, I; Albaladejo, P

    2011-09-01

    Direct oral anticoagulants (DOAs), inhibitors of factor IIa or Xa, are expected to replace vitamin K antagonists in most of their indications. It is likely that patients on long-term treatment with DOAs will be exposed to elective or emergency surgery or invasive procedures. Due to the present lack of experience in such conditions, we cannot make recommendations, but only propose perioperative management for optimal safety as regards the risk of bleeding and thrombosis. DOAs may increase surgical bleeding, they have no validated antagonists, they cannot be monitored by simple, standardised laboratory assays, and their pharmacokinetics vary significantly from patient to patient. Although DOAs differ in many respects, the proposals in the perioperative setting need not be specific to each. For procedures with low risk of haemorrhage, a therapeutic window of 48 h (last administration 24h before surgery, restart 24h after) is proposed. For procedures with medium or high haemorrhagic risk, we suggest stopping DOAs 5 days before surgery to ensure complete elimination of the drug in all patients. The treatment should be resumed only when the risk of bleeding has been controlled. In patients with a high risk of thrombosis (e.g. those in atrial fibrillation with an antecedent of stroke), bridging with heparin (low molecular weight, or unfractionated if the former is contraindicated) is proposed. In emergency, the procedure should be postponed for as long as possible (minimum 1-2 half-lives) and non-specific anti-haemorrhagic agents, such as recombinant human activated factor VIIa, or prothrombin concentrates, should not be given for prophylactic reversal, due to their uncertain benefit-risk. PMID:21820844

  2. Stapedectomy - long-term report.

    PubMed

    Shea, J J

    1982-01-01

    The long-term results with large fenestra stapedectomy with vein graft and Teflon piston are compared with results with the small fenestra stapedectomy with teflon piston directly into the vestibule. There were 1,943 operations in the former group and 2,155 in the latter when compared in 1970. One hundred consecutive patients from the beginning of each group with follow-up to present were compared. Results were generally the same with no great change in 15 and 20 years as compared to those at 5 years. The complication of perilymph fistula was caused by creating an opening in the footplate much larger than the prosthesis and was eliminated by interposing a living oval window seal if the opening was much larger than the prosthesis and a flap of lining membrane from the promontory when it was not. Other factors that influence a good result are discussed, including the type and the diameter of the piston used, the type of living oval window seal and the method of attachment to the incus. The small fenestra operation was found to be superior to the large, not only for the hearing gain achieved, but the case of performance and the freedom from complications due to migration of the prosthesis and/or the oval window seal. At present we have done about all that can be done for the conductive components. What remains is the sensorineural component which our studies indicate may be due to an autoimmune response. PMID:6897157

  3. Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China

    PubMed Central

    Hu, Hai-Jie; Mao, Hui; Shrestha, Anuj; Tan, Yong-Qiong; Ma, Wen-Jie; Yang, Qin; Wang, Jun-Ke; Cheng, Nan-Sheng; Li, Fu-Yu

    2016-01-01

    AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution. METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses. RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin. CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent

  4. Long-term precipitation forecast for drought relief using atmospheric circulation factors: a study on the Maharloo Basin in Iran

    NASA Astrophysics Data System (ADS)

    Sigaroodi, S. K.; Chen, Q.; Ebrahimi, S.; Nazari, A.; Choobin, B.

    2014-05-01

    Long-term precipitation forecasts can help to reduce drought risk through proper management of water resources. This study took the saline Maharloo Lake, which is located in the north of Persian Gulf, southern Iran, and is continuously suffering from drought disaster, as a case to investigate the relationships between climatic indices and precipitation. Cross-correlation in combination with stepwise regression technique was used to determine the best variables among 40 indices and identify the proper time lag between dependent and independent variables for each month. The monthly precipitation was predicted using an artificial neural network (ANN) and multi-regression stepwise methods, and results were compared with observed rainfall data. Initial findings indicated that climate indices such as NAO (North Atlantic Oscillation), PNA (Pacific North America) and El Niño are the main indices to forecast drought in the study area. According to R2, root mean square error (RMSE) and Nash-Sutcliffe efficiency, the ANN model performed better than the multi-regression model, which was also confirmed by classification results. Moreover, the model accuracy to forecast the rare rainfall events in dry months (June to October) was higher than the other months. From the findings it can be concluded that there is a relationship between monthly precipitation anomalies and climatic indices in the previous 10 months in Maharloo Basin. The highest and lowest accuracy of the ANN model were in September and March, respectively. However, these results are subject to some uncertainty due to a coarse data set and high system complexity. Therefore, more research is necessary to further elucidate the relationship between climatic indices and precipitation for drought relief. In this regard, consideration of other climatic and physiographic factors (e.g., wind and physiography) can be helpful.

  5. Long-term cyclosporine treatment in non-transplanted rats and metabolic risk factors of vascular diseases.

    PubMed

    Böhmer, Ana Elisa; Souza, Débora Guerini; Hansel, Gisele; Brum, Liz M B P; Portela, Luis Valmor; Souza, Diogo Onofre

    2010-04-15

    Cyclosporine (CsA) is an immunosuppressive agent frequently used in the clinic for prevention of allograft rejection and for the treatment of autoimmune diseases. Despite its desired action on the immune system, CsA treatment may present serious adverse effects, which are masked by the concomitant use of other drugs. The search for effective immunosuppression protocols which does not affect the quality of life of patients is driving research to investigate the CsA involvement in vascular diseases, frequent in patients under immunosuppression. Thus, 45 non-transplanted Wistar rats were treated for 8 weeks with vehicle or 5 or 15 mg/kg CsA (n=15/group) by gavage administration to evaluate the specific influence of cyclosporine on the levels of risk factors (metabolic and inflammatory) of vascular disease and its mechanism of action. Therefore, serum insulin levels, glucose tolerance test, serum lipids profile, total homocysteine and fibrinogen levels were assessed. The biochemical alterations reported here suggest the development of a framework straight to diabetes. Glucose homeostasis was affected as indicated by decreased insulin levels and altered glucose tolerance test in CsA 15 mg/kg group compared to other groups. Serum insulin and total homocysteine levels presented a significant negative correlation (R=- 0.76, P<0.0001). Fibrinogen and serum lipids profiles were significantly increased in CsA 15 mg/kg group compared to other groups and correlated positively with total homocysteine levels. Considering the well-established correlation among insulin resistance, lipid and total homocysteine levels, hypercoagulability and atherosclerosis, we can assume that this protocol of long-term CsA treatment in non-transplanted rats alter biochemical parameters related to cardiovascular and cerebrovascular risk, mainly in CsA 15 mg/kg group. Insulin and tHcy serum levels appear to be central in this process. PMID:20188083

  6. Long-Term Results and Predictive Factors of Three-Dimensional Conformal Salvage Radiotherapy for Biochemical Relapse After Prostatectomy

    SciTech Connect

    Neuhof, Dirk . E-mail: dirk.neuhof@med.uni-heidelberg.de; Hentschel, Tina; Bischof, Marc; Sroka-Perez, Gabriele; Hohenfellner, Markus; Debus, Juergen

    2007-04-01

    Purpose: Salvage radiotherapy (RT) is used to treat patients with biochemical failure after radical prostatectomy (RP). Although retrospective series have demonstrated that salvage RT will result in biochemical response in approximately 75% of patients, long-term response is much lower (20-40%). The purpose of this study was to determine prognostic factors related to the prostate-specific antigen (PSA) outcome after salvage RT. Methods and Materials: Between 1991 and 2004, 171 patients received salvage RT at University of Heidelberg. Patient age, margin status, Gleason score, tumor grading, pathologic tumor stage, pre-RP and pre-RT PSA levels, and time from RP to rise of PSA were analyzed. Results: Median follow-up time was 39 months. The 5-year overall and clinical relapse-free survival were 93.8% and 80.8%, respectively. After RT serum PSA decreased in 141 patients (82.5%). The 5-year biochemical relapse-free survival was 35.1%. Univariate analysis showed following statistically significant predictors of PSA recurrence after RT: preoperative PSA level (p = 0.035), pathologic tumor classification (p 0.001), Gleason score (p < 0.001), tumor grading (p = 0.004), and pre-RT PSA level (p = 0.031). On multivariate analysis, only Gleason score (p = 0.047) and pre-RT PSA level (p = 0.049) were found to be independently predictive of PSA recurrence. Conclusions: This study represents one of the largest retrospective studies analyzing the outcome of patients treated with salvage RT at a single institution. Our findings suggest that patients with Gleason score <7 and low pre-RT PSA levels are the best candidates for salvage RT, whereas patients with high-grade lesions should be considered for additional treatment (e.g., hormonal therapy)

  7. Four-Year Weight Losses in the Look AHEAD Study: Factors Associated with Long-Term Success

    PubMed Central

    Wadden, Thomas A.; Neiberg, Rebecca H.; Wing, Rena R.; Clark, Jeanne M.; Delahanty, Linda M.; Hill, James O.; Krakoff, Jonathan; Otto, Amy; Ryan, Donna H.; Vitolins, Mara Z.

    2011-01-01

    This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long-term success. A total of 5145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care group, referred to as Diabetes Support and Education (DSE). ILI participants were provided approximately weekly group or individual treatment in year 1; continued but less frequent contact was provided in years 2–4. DSE participants received three group educational sessions in all years. As reported previously, at year 4, ILI participants lost an average of 4.7% of initial weight, compared with 1.1% for DSE (p<0.0001). More ILI than DSE participants lost ≥5% (46% vs 25%, p<0.0001) and ≥10% (23% vs 10%, p<0.0001) of initial weight. Within the ILI, acheivement of both the 5% and 10% categorical weight losses at year 4 was strongly related to meeting these goals at year 1. A total of 887 participants in ILI lost ≥10% at year 1, of whom 374 (42.2%) achieved this loss at year 4. Participants who maintained the loss, compared with those who did not, attended more treatment sessions and reported more favorable physical activity and food intake at year 4. These results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years. PMID:21779086

  8. Four-year weight losses in the Look AHEAD study: factors associated with long-term success.

    PubMed

    Wadden, Thomas A; Neiberg, Rebecca H; Wing, Rena R; Clark, Jeanne M; Delahanty, Linda M; Hill, James O; Krakoff, Jonathan; Otto, Amy; Ryan, Donna H; Vitolins, Mara Z

    2011-10-01

    This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long-term success. A total of 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care group, referred to as Diabetes Support and Education (DSE). ILI participants were provided approximately weekly group or individual treatment in year 1; continued but less frequent contact was provided in years 2-4. DSE participants received three group educational sessions in all years. As reported previously, at year 4, ILI participants lost an average of 4.7% of initial weight, compared with 1.1% for DSE (P < 0.0001). More ILI than DSE participants lost ≥ 5% (46% vs. 25%, P < 0.0001) and ≥ 10% (23% vs. 10%, P < 0.0001) of initial weight. Within the ILI, achievement of both the 5% and 10% categorical weight losses at year 4 was strongly related to meeting these goals at year 1. A total of 887 participants in ILI lost ≥ 10% at year 1, of whom 374 (42.2%) achieved this loss at year 4. Participants who maintained the loss, compared with those who did not, attended more treatment sessions and reported more favorable physical activity and food intake at year 4. These results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥ 5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years. PMID:21779086

  9. Soil-to-Crop Transfer Factors of Naturally Occurring Radionuclides and Stable Elements for Long-Term Dose Assessment

    SciTech Connect

    Uchida, S.; Tagami, K.

    2007-07-01

    A soil-to-crop transfer factor, TF, is a key parameter that directly affects the internal dose assessment for the ingestion pathway, however, obtaining TFs of various long-lived radionuclides occurred during operation of nuclear power plants is difficult because most of them could not be found in natural environments. In this study, therefore, we collected crops and their associated soils throughout Japan and measured more than 50 elements to obtain TFs under equilibrium conditions. The TFs were calculated for 42 elements (Li, Na, Mg, Al, Si, P, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Y, Mo, Cd, Sn, I, Cs, Ba, La, Ce, Pr, Nd, Sm, Eu, Gd, Dy, Ho, Er, Tl, Pb, Th and U) from their concentrations in both crop and soil samples. The TF is defined as the concentration of an isotope in a crop (in Bq/kg or mg/kg dry weight) divided by the concentration of the isotope in soil (in Bq.kg or mg/kg dry weight). Probability distributions of TFs for 62 upland field crops were usually log-normal type so that geometric means (GMs) were calculated. The values for the elements of interest from the viewpoint of long-term dose assessment were 2.5E-02 for Se, 7.9E-02 for Sr, 3.1E-03 for Cs, 4.2E-04 for Th and 4.6E-04 for U. Leafy vegetable showed the highest TFs for all the elements among the crop groups. It was clear that these data were usually within the 95% confidence limits of TFs compiled by IAEA in Technical Report Series 364. (authors)

  10. Risk Factors for Tardive Dyskinesia in Adults with Intellectual Disability, Comorbid Psychopathology, and Long-Term Psychotropic Use

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Fodstad, Jill C.; Neal, Daniene; Dempsey, Timothy; Rivet, Tessa T.

    2010-01-01

    Psychotropic medications are commonly used as an adjunct treatment in large-scale residential care facilities for adults with developmental disabilities. While the benefits of medication are noted, there are very severe conditions that can result from long term medication use. Tardive dyskinesia (TD) manifests as a variety of involuntary,…

  11. Risk Factors for Complications of Traumatic Injuries.

    PubMed

    de Aguiar Júnior, Wagner; Saleh, Carmen Mohamad Rida; Whitaker, Iveth Yamaguchi

    2016-01-01

    Complications in hospitalized trauma patients are major causes of morbidity and mortality. The aims of this study were to identify the in-hospital trauma patients' complications and identify the risk factors for complications in this population. A retrospective analysis was conducted in a sample from a Brazilian hospital. The sample consisted of 407 patients, 194 (47.66%) of whom had records of complications. The most common complications were infections (41.80%). The risk factors related to the complications were age, length of hospital stay, external causes, and injury severity. The complications were frequent in this sample, and the risk for complications was characterized by multiple factors. PMID:27618375

  12. Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: Long-term experience and prognostic factors

    SciTech Connect

    Milker-Zabel, Stefanie . E-mail: stefanie_milker-zabel@med.uni-heidelberg.de; Zabel, Angelika; Schulz-Ertner, Daniela; Schlegel, Wolfgang; Wannenmacher, Michael; Debus, Juergen

    2005-03-01

    Purpose: To analyze our long-term experience and prognostic factors after fractionated stereotactic radiotherapy (FSRT) in patients with benign or atypical intracranial meningioma. Methods and materials: Between January 1985 and December 2001, 317 patients with a median age of 55.7 years were treated with FSRT for intracranial meningioma. The tumor distribution was World Health Organization (WHO) Grade 1 in 48.3%, WHO Grade 2 in 8.2%, and unknown in 43.5%. Of the 317 patients, 97 underwent RT as their primary treatment, 79 underwent postoperative RT (subtotal resection in 38 and biopsy only in 41), and 141 were treated for recurrent disease. The median target volume was 33.6 cm{sup 3} (range, 1.0-412.6 cm{sup 3}). The median total dose was 57.6 Gy at 1.8 Gy/fraction five times weekly. Results: The median follow-up was 5.7 years (range, 1.2-14.3 years). The overall local tumor control rate was 93.1% (295 of 317). Of the 317 patients, 72 had a partial response on CT/MRI and 223 (70.4%) remained stable. At a median of 4.5 years after FSRT, 22 patients (6.9%) had local tumor progression on MRI. Local tumor failure was significantly greater in patients with WHO Grade 2 meningioma (p < 0.002) than in patients with WHO Grade 1 or unknown histologic features. Patients treated for recurrent meningioma showed a trend toward decreased progression-free survival compared with patients treated with primary therapy, after biopsy, or after subtotal resection (p < 0.06). Patients with a tumor volume >60 cm{sup 3} had a recurrence rate of 15.5% vs. 4.3% for those with a tumor volume of {<=}60 cm{sup 3} (p < 0.001). In 42.9% of the patients, preexisting neurologic deficits improved. Worsening of preexisting neurologic symptoms occurred in 8.2%. Eight patients developed new clinical symptoms, such as reduced vision, trigeminal neuralgia, and intermittent tinnitus located at the side of the irradiated meningioma after FSRT. Conclusion: These data have demonstrated that FSRT is an

  13. Bridging Grafts and Transient Nerve Growth Factor Infusions Promote Long-Term Central Nervous System Neuronal Rescue and Partial Functional Recovery

    NASA Astrophysics Data System (ADS)

    Tuszynski, Mark H.; Gage, Fred H.

    1995-05-01

    Grafts of favorable axonal growth substrates were combined with transient nerve growth factor (NGF) infusions to promote morphological and functional recovery in the adult rat brain after lesions of the septohippocampal projection. Long-term septal cholinergic neuronal rescue and partial hippocampal reinnervation were achieved, resulting in partial functional recovery on a simple task assessing habituation but not on a more complex task assessing spatial reference memory. Control animals that received transient NGF infusions without axonal-growth-promoting grafts lacked behavioral recovery but also showed long-term septal neuronal rescue. These findings indicate that (i) partial recovery from central nervous system injury can be induced by both preventing host neuronal loss and promoting host axonal regrowth and (ii) long-term neuronal loss can be prevented with transient NGF infusions.

  14. c-Rel, an NF-[kappa]B Family Transcription Factor, Is Required for Hippocampal Long-Term Synaptic Plasticity and Memory Formation

    ERIC Educational Resources Information Center

    Ahn, Hyung Jin; Hernandez, Caterina M.; Levenson, Jonathan M.; Lubin, Farah D.; Liou, Hsiou-Chi; Sweatt, J. David

    2008-01-01

    Transcription is a critical component for consolidation of long-term memory. However, relatively few transcriptional mechanisms have been identified for the regulation of gene expression in memory formation. In the current study, we investigated the activity of one specific member of the NF-[kappa]B transcription factor family, c-Rel, during…

  15. Death in Long-term Care: A Brief Report Examining Factors Associated with Death within 31 Days of Assessment

    PubMed Central

    Brink, Peter; Kelley, Mary Lou

    2015-01-01

    INTRODUCTION The ability to estimate prognosis using administrative data has already been established. Research indicates that residents newly admitted to long-term care are at a higher risk of mortality. Studies have also examined mortality within 90 days or a year. Focusing on 31 days from assessment was important because it appears to be clinically useful for care planning in end-of-life; whereby, greater utility may come from identifying residents who are at risk of death within a shorter time frame so that advance care planning can occur. PURPOSE To examine risk of mortality within 31 days of assessment among long-term care residents using administrative health data. METHODS Administrative data were used to examine risk of mortality within 31 days of assessment among all long-term care residents in Ontario over a 12-month period. Data were provided by the Canadian Institute for Health Information using the Continuing Care Reporting System (CCRS), Discharge Abstract Database (DAD), and the National Ambulatory Care Reporting System (NACRS). RESULTS A number of diagnoses and health conditions predict death within 31 days. Diagnoses that hold an increased risk of mortality include pulmonary disease, diagnosis of cancer, and heart disease. Health conditions that lead to an increased likelihood of death include weight loss, dehydration, and shortness of breath. The presence of a fall within the last 30 days was also related to a higher risk of mortality. DISCUSSION Long-term care residents who lose weight, have persistent problems with hydration, and suffer from shortness of breath are at particular risk of death. The presence of advanced directives also predicts death within 31 days of assessment. PMID:25674000

  16. [Long-term-management of organ transplant recipients].

    PubMed

    Bürger, Christin; Schmidt, Martina; Maschmeier, Miriam; Stella, Jaqueline; Hüsing, Anna; Wilms, Christian; Schmidt, Hartmut Hans-Jürgen; Kabar, Iyad

    2016-07-01

    Due to advances in immunosuppressive therapy and surgical techniques, survival rates after solid organ transplantation have constantly improved over the last decades. In long-term care after transplantation, physicians need to focus as much on diagnosis and treatment of allograft-related complications as they should consider comorbidities and evaluate risk-factors and adverse events of immunosuppressive agents to prevent secondary diseases. In particular, cardiovascular and metabolic diseases, malignancy and infection play a major role in long-term survival. Therefore, screening of organ transplant recipients in regard to these complications and adverse events is a crucial part of follow up in these patients. PMID:27359310

  17. Predictive factors of the long term outcome in gastro-oesophageal reflux disease: six year follow up of 107 patients.

    PubMed Central

    Kuster, E; Ros, E; Toledo-Pimentel, V; Pujol, A; Bordas, J M; Grande, L; Pera, C

    1994-01-01

    There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived. PMID:8307456

  18. Prognostic factors in ovarian carcinoma stage III patients. Can biomarkers improve the prediction of short- and long-term survivors?

    PubMed

    Kaern, J; Aghmesheh, M; Nesland, J M; Danielsen, H E; Sandstad, B; Friedlander, M; Tropé, C

    2005-01-01

    The aim of the study was to determine if biomarker expression could help discriminate between short-term and long-term survivors in women with advanced ovarian cancer. Fifty-one patients with stage III ovarian cancer were selected for the study, which included 28 short-term survivors (death from ovarian cancer within 18 months) and 23 long-term survivors (alive for more than 5 years). There was no difference between the two groups with respect to FIGO substage, age, World Health Organization score, and first-line platinum therapy. Classic clinical pathologic parameters were examined together with p53, Bcl-2, Ki-67, PDGFRalpha, P-glycoprotein, BRCA1, and DNA ploidy. Immunohistochemistry was used for scoring biomarker expression and image cytometry for DNA ploidy. All patients had primary debulking surgery followed by first-line platinum therapy. On multivariate analysis, the presence of ascites, debulking surgery and repeat laparotomy, clear-cell histology, elevated CA125, and high Ki-67 score were all found to be of prognostic importance. The long-term survivors were characterized by primary optimal cytoreduction surgery (<1 cm residual disease), attempt at maximal tumor debulking by experienced gynecological oncologic surgeons, and the absence of ascites. Normal CA125 level before platinum therapy and negative Ki-67 expression also predicted a more favorable prognosis. PMID:16343177

  19. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational.

    PubMed

    Squires, Janet E; Hoben, Matthias; Linklater, Stefanie; Carleton, Heather L; Graham, Nicole; Estabrooks, Carole A

    2015-01-01

    Despite an increasing literature on professional nurses' job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care. PMID:26345545

  20. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational

    PubMed Central

    Squires, Janet E.; Hoben, Matthias; Linklater, Stefanie; Carleton, Heather L.; Graham, Nicole; Estabrooks, Carole A.

    2015-01-01

    Despite an increasing literature on professional nurses' job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care. PMID:26345545

  1. Spatial Analysis of Factors Influencing Long-Term Stress in the Grizzly Bear (Ursus arctos) Population of Alberta, Canada

    PubMed Central

    Bourbonnais, Mathieu L.; Nelson, Trisalyn A.; Cattet, Marc R. L.; Darimont, Chris T.; Stenhouse, Gordon B.

    2013-01-01

    Non-invasive measures for assessing long-term stress in free ranging mammals are an increasingly important approach for understanding physiological responses to landscape conditions. Using a spatially and temporally expansive dataset of hair cortisol concentrations (HCC) generated from a threatened grizzly bear (Ursus arctos) population in Alberta, Canada, we quantified how variables representing habitat conditions and anthropogenic disturbance impact long-term stress in grizzly bears. We characterized spatial variability in male and female HCC point data using kernel density estimation and quantified variable influence on spatial patterns of male and female HCC stress surfaces using random forests. Separate models were developed for regions inside and outside of parks and protected areas to account for substantial differences in anthropogenic activity and disturbance within the study area. Variance explained in the random forest models ranged from 55.34% to 74.96% for males and 58.15% to 68.46% for females. Predicted HCC levels were higher for females compared to males. Generally, high spatially continuous female HCC levels were associated with parks and protected areas while low-to-moderate levels were associated with increased anthropogenic disturbance. In contrast, male HCC levels were low in parks and protected areas and low-to-moderate in areas with increased anthropogenic disturbance. Spatial variability in gender-specific HCC levels reveal that the type and intensity of external stressors are not uniform across the landscape and that male and female grizzly bears may be exposed to, or perceive, potential stressors differently. We suggest observed spatial patterns of long-term stress may be the result of the availability and distribution of foods related to disturbance features, potential sexual segregation in available habitat selection, and may not be influenced by sources of mortality which represent acute traumas. In this wildlife system and others

  2. Spatial analysis of factors influencing long-term stress in the grizzly bear (Ursus arctos) population of Alberta, Canada.

    PubMed

    Bourbonnais, Mathieu L; Nelson, Trisalyn A; Cattet, Marc R L; Darimont, Chris T; Stenhouse, Gordon B

    2013-01-01

    Non-invasive measures for assessing long-term stress in free ranging mammals are an increasingly important approach for understanding physiological responses to landscape conditions. Using a spatially and temporally expansive dataset of hair cortisol concentrations (HCC) generated from a threatened grizzly bear (Ursus arctos) population in Alberta, Canada, we quantified how variables representing habitat conditions and anthropogenic disturbance impact long-term stress in grizzly bears. We characterized spatial variability in male and female HCC point data using kernel density estimation and quantified variable influence on spatial patterns of male and female HCC stress surfaces using random forests. Separate models were developed for regions inside and outside of parks and protected areas to account for substantial differences in anthropogenic activity and disturbance within the study area. Variance explained in the random forest models ranged from 55.34% to 74.96% for males and 58.15% to 68.46% for females. Predicted HCC levels were higher for females compared to males. Generally, high spatially continuous female HCC levels were associated with parks and protected areas while low-to-moderate levels were associated with increased anthropogenic disturbance. In contrast, male HCC levels were low in parks and protected areas and low-to-moderate in areas with increased anthropogenic disturbance. Spatial variability in gender-specific HCC levels reveal that the type and intensity of external stressors are not uniform across the landscape and that male and female grizzly bears may be exposed to, or perceive, potential stressors differently. We suggest observed spatial patterns of long-term stress may be the result of the availability and distribution of foods related to disturbance features, potential sexual segregation in available habitat selection, and may not be influenced by sources of mortality which represent acute traumas. In this wildlife system and others

  3. Long-term Delivery of Nerve Growth Factor by Encapsulated Cell Biodelivery in the Göttingen Minipig Basal Forebrain

    PubMed Central

    Fjord-Larsen, Lone; Kusk, Philip; Tornøe, Jens; Juliusson, Bengt; Torp, Malene; Bjarkam, Carsten R; Nielsen, Mette S; Handberg, Aase; Sørensen, Jens Christian H; Wahlberg, Lars U

    2010-01-01

    Nerve growth factor (NGF) prevents cholinergic degeneration in Alzheimer's disease (AD) and improves memory in AD animal models. In humans, the safe delivery of therapeutic doses of NGF is challenging. For clinical use, we have therefore developed an encapsulated cell (EC) biodelivery device, capable of local delivery of NGF. The clinical device, named NsG0202, houses an NGF-secreting cell line (NGC-0295), which is derived from a human retinal pigment epithelial (RPE) cell line, stably genetically modified to secrete NGF. Bioactivity and correct processing of NGF was confirmed in vitro. NsG0202 devices were implanted in the basal forebrain of Göttingen minipigs and the function and retrievability were evaluated after 7 weeks, 6 and 12 months. All devices were implanted and retrieved without associated complications. They were physically intact and contained a high number of viable and NGF-producing NGC-0295 cells after explantation. Increased NGF levels were detected in tissue surrounding the devices. The implants were well tolerated as determined by histopathological brain tissue analysis, blood analysis, and general health status of the pigs. The NsG0202 device represents a promising approach for treating the cognitive decline in AD patients. PMID:20664524

  4. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

    PubMed Central

    Mazzei, Maria Antonietta; Guerrini, Susanna; Mazzei, Francesco Giuseppe; Cioffi Squitieri, Nevada; Notaro, Dario; de Donato, Gianmarco; Galzerano, Giuseppe; Sacco, Palmino; Setacci, Francesco; Volterrani, Luca; Setacci, Carlo

    2016-01-01

    AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard. METHODS: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d. RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively. CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases. PMID:27247719

  5. Effects of Relocation and Individual and Environmental Factors on the Long-Term Stress Levels in Captive Chimpanzees (Pan troglodytes): Monitoring Hair Cortisol and Behaviors.

    PubMed

    Yamanashi, Yumi; Teramoto, Migaku; Morimura, Naruki; Hirata, Satoshi; Inoue-Murayama, Miho; Idani, Gen'ichi

    2016-01-01

    Understanding the factors associated with the long-term stress levels of captive animals is important from the view of animal welfare. In this study, we investigated the effects of relocation in addition to individual and environmental factors related to social management on long-term stress level in group-living captive chimpanzees by examining behaviors and hair cortisol (HC). Specifically, we conducted two studies. The first compared changes in HC levels before and after the relocation of 8 chimpanzees (Study 1) and the second examined the relationship between individual and environmental factors and individual HC levels in 58 chimpanzees living in Kumamoto Sanctuary (KS), Kyoto University (Study 2). We hypothesized that relocation, social situation, sex, and early rearing conditions, would affect the HC levels of captive chimpanzees. We cut arm hair from chimpanzees and extracted and assayed cortisol with an enzyme immunoassay. Aggressive behaviors were recorded ad libitum by keepers using a daily behavior monitoring sheet developed for this study. The results of Study 1 indicate that HC levels increased during the first year after relocation to the new environment and then decreased during the second year. We observed individual differences in reactions to relocation and hypothesized that social factors may mediate these changes. In Study 2, we found that the standardized rate of receiving aggression, rearing history, sex, and group formation had a significant influence on mean HC levels. Relocation status was not a significant factor, but mean HC level was positively correlated with the rate of receiving aggression. Mean HC levels were higher in males than in females, and the association between aggressive interactions and HC levels differed by sex. These results suggest that, although relocation can affect long-term stress level, individuals' experiences of aggression and sex may be more important contributors to long-term stress than relocation alone. PMID

  6. Effects of Relocation and Individual and Environmental Factors on the Long-Term Stress Levels in Captive Chimpanzees (Pan troglodytes): Monitoring Hair Cortisol and Behaviors

    PubMed Central

    Yamanashi, Yumi; Teramoto, Migaku; Morimura, Naruki; Hirata, Satoshi; Inoue-Murayama, Miho; Idani, Gen'ichi

    2016-01-01

    Understanding the factors associated with the long-term stress levels of captive animals is important from the view of animal welfare. In this study, we investigated the effects of relocation in addition to individual and environmental factors related to social management on long-term stress level in group-living captive chimpanzees by examining behaviors and hair cortisol (HC). Specifically, we conducted two studies. The first compared changes in HC levels before and after the relocation of 8 chimpanzees (Study 1) and the second examined the relationship between individual and environmental factors and individual HC levels in 58 chimpanzees living in Kumamoto Sanctuary (KS), Kyoto University (Study 2). We hypothesized that relocation, social situation, sex, and early rearing conditions, would affect the HC levels of captive chimpanzees. We cut arm hair from chimpanzees and extracted and assayed cortisol with an enzyme immunoassay. Aggressive behaviors were recorded ad libitum by keepers using a daily behavior monitoring sheet developed for this study. The results of Study 1 indicate that HC levels increased during the first year after relocation to the new environment and then decreased during the second year. We observed individual differences in reactions to relocation and hypothesized that social factors may mediate these changes. In Study 2, we found that the standardized rate of receiving aggression, rearing history, sex, and group formation had a significant influence on mean HC levels. Relocation status was not a significant factor, but mean HC level was positively correlated with the rate of receiving aggression. Mean HC levels were higher in males than in females, and the association between aggressive interactions and HC levels differed by sex. These results suggest that, although relocation can affect long-term stress level, individuals’ experiences of aggression and sex may be more important contributors to long-term stress than relocation alone

  7. Does the Method of Weight Loss Effect Long-Term Changes in Weight, Body Composition or Chronic Disease Risk Factors in Overweight or Obese Adults? A Systematic Review

    PubMed Central

    Washburn, Richard A.; Szabo, Amanda N.; Lambourne, Kate; Willis, Erik A.; Ptomey, Lauren T.; Honas, Jeffery J.; Herrmann, Stephen D.; Donnelly, Joseph E.

    2014-01-01

    Background Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain. Objective To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors. Data Sources PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review. Study Eligibility Criteria Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included. Study Appraisal and Synthesis Methods Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up). Results Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise. PMID:25333384

  8. Interacting Factors That Influence Long-term Storage of Live Pasteurella tularensis Vaccine and Rift Valley Fever Virus

    PubMed Central

    Klein, Frederick; Walker, Jerry S.; Mahlandt, Bill G.; Carter, Richard C.; Orlando, Michael D.; Weirether, Francis J.; Lincoln, Ralph E.

    1969-01-01

    Studies were conducted on the interaction of various parameters which affect the storage stability and growth potential of liquid cultures of Pasteurella tularensis live vaccine strain (LVS) and Rift Valley fever virus Van Wyk strain (RVFV). Storage variables studied with LVS included four storage temperatures (4, -20, -65, -175 C), single and multiple freeze-thaw cycles, two freezing and two thawing rates (slow and fast), various inoculum levels (1, 3, 5, and 10%) for the determination of growth potential, and the retention of immunizing potential (mice and guinea pig) after storage. Neither the freezing rate nor the number of freeze-thaw cycles seriously affected the growth of LVS after storage at -175C; however, the slow rate of thaw proved deleterious as were all temperatures of storage except -175 C after 1 year of storage, as shown by both criteria of evaluation. RVFV produced in two combinations of cell lines and media (LM cell line-199 peptone medium and LDR cell line-Eagle's minimum essential medium) was stored at three serum levels (10, 20, 40%), three pH values (6.2., 7.0, 7.8), and three temperatures (-20, -65, -175 C). These studies indicated: (i) virus produced in the LDR cell line and Eagle's medium was more stable than that produced in the LM cell line and 199 peptone medium for either short- or long-term storage; (ii) serum levels did not affect stability; and (iii) low pH resulted in losses during long-term storage under all conditions tested. Thus, cryogenic storage is advantageous for stock culture maintenance of bacteria and viruses and for other similar applications. PMID:5780399

  9. Cultivar and Tree Density As Key Factors in the Long-Term Performance of Super High-Density Olive Orchards.

    PubMed

    Díez, Concepción M; Moral, Juan; Cabello, Diego; Morello, Pablo; Rallo, Luis; Barranco, Diego

    2016-01-01

    Super high-density (SHD) olive orchards are rapidly expanding since the first plantation was set up in Spain in the 1990s. Because there are no long-term studies characterizing these systems, it is unknown if densities above a certain threshold could trigger competition among fully-grown trees, compromising their development. Over 14 years we have evaluated the performance of the major olive cultivars currently planted in SHD systems ("Arbequina," Arbequina IRTA-i·18, "Arbosana," "Fs-17," and "Koroneiki") and nine SHD designs ranging from 780 to 2254 trees ha(-1) for the cultivar "Arbequina." Remarkably, the accumulated fruit and oil production of the five cultivars increased linearly over time. Our data indicated the favorable long-term performance of the evaluated cultivars with an average annual oil production of 2.3 t ha(-1). Only "Fs-17" did not perform well to the SHD system in our conditions and it yielded about half (1.2 t ha(-1)) of the other cultivars. In the density trial for "Arbequina," both fruit and oil accumulated production increased over time as a function of tree density. Thus, the accumulated oil yield ranged from 16.1 t ha(-1) for the lowest density (780 trees ha(-1)) to 29.9 t ha(-1) for the highest (2254 trees ha(-1)). In addition, we note that the accumulated production per surface unit showed a better correlation with the hedgerow length than the tree density. Thus, the current planting designs of SHD olive orchards can be further improved taking this parameter into account. Despite observations that some irregular patterns of crop distribution have arisen, our olive hedgerows are still fully productive after 14 years of planting. This result contradicts previous experiences that showed declines in production 7 or 8 years after planting due to high vigor, shading, and limited ventilation. PMID:27602035

  10. The road to success. Long-term prognosis for persons living with HIV in Denmark - time trends and risk factors.

    PubMed

    Lohse, Nicolai

    2016-02-01

    detection practice. Once diagnosed, getting the full benefit of modern HIV care requires access to a good healthcare system. We compared temporal trends in quality and quantity of ART introduction in Den-mark and Greenland. Despite similar levels of health worker education and economic resources, ART implementation and mortality decline in Greenland lacked several years behind Denmark. The study reminded us that although economy may be a prerequisite for implementing an effective HIV care system, it is certainly not all it takes. The nationwide nature of the Danish HIV Cohort Study also allowed us to study a number of time trends at the population level. Despite what was feared, we found that the prevalence of triple-drug class virological failure (TCF) seemed to have stabilized after 2000; that the incidence rates of drug resistance acquisition were decreasing during 1999-2005; and that the prevalence of potential transmitters of drug-resistant HIV decreased during 1997-2004. We also looked at some of the consequences of virological failure and drug resistance and found that even modest levels of viraemia were associated with a high risk of future failure and death, and that in persons who have experienced TCF, the number and pattern of resistance mutations were independent predictors of death. Hence, despite the overall positive trends in virological failure and drug-resistance development at the population level, our findings underline the crucial importance of always having an effective treatment option available for the individual patient with drug-resistant virus. As mortality was declining for persons with access to ART and good HIV care, it became important to know how long persons with HIV could expect to live compared to the general population. We projected long-term survival and found that a 25-year old person with HIV and without hepatitis C virus (HCV) co-infection had a 50 per cent chance of surviving another 39 years, only 12.2 years less than a person in a

  11. Factors Associated with Long-Term Sickness Absence Due to Mental Disorders: A Cohort Study of 7.112 Patients during the Spanish Economic Crisis

    PubMed Central

    Real, Eva; Jover, Lluís; Verdaguer, Ricard; Griera, Antoni; Segalàs, Cinto; Alonso, Pino; Contreras, Fernando; Arteman, Antoni; Menchón, José M.

    2016-01-01

    Background Mental health problems are very common and often lead to prolonged sickness absence, having serious economic repercussions for most European countries. Periods of economic crisis are important social phenomena that are assumed to increase sickness absence due to mental disorders, although research on this topic remains scarce. The aim of this study was to gather data on long-term sickness absence (and relapse) due to mental disorders in Spain during a period of considerable socio-economic crisis. Methods Relationships were analyzed (using chi-squared tests and multivariate modelling via binary logistic regression) between clinical, social/employment-related and demographic factors associated and long-term sickness absence (>60 consecutive days) due to mental disorders in a cohort of 7112 Spanish patients during the period 2008–2012. Results Older age, severe mental disorders, being self-employed, having a non-permanent contract, and working in the real estate and construction sector were associated with an increased probability of long-term sickness absence (gender had a mediating role with respect to some of these variables). Relapses were associated with short-term sick leave (return to work due to ‘improvement’) and with working in the transport sector and public administration. Conclusions Aside from medical factors, other social/employment-related and demographic factors have a significant influence on the duration of sickness absence due to mental disorders. PMID:26730603

  12. Roles of vascular and metabolic components in cognitive dysfunction of Alzheimer disease: short- and long-term modification by non-genetic risk factors.

    PubMed

    Sato, Naoyuki; Morishita, Ryuichi

    2013-01-01

    It is well known that a specific set of genetic and non-genetic risk factors contributes to the onset of Alzheimer disease (AD). Non-genetic risk factors include diabetes, hypertension in mid-life, and probably dyslipidemia in mid-life. This review focuses on the vascular and metabolic components of non-genetic risk factors. The mechanisms whereby non-genetic risk factors modify cognitive dysfunction are divided into four components, short- and long-term effects of vascular and metabolic factors. These consist of (1) compromised vascular reactivity, (2) vascular lesions, (3) hypo/hyperglycemia, and (4) exacerbated AD histopathological features, respectively. Vascular factors compromise cerebrovascular reactivity in response to neuronal activity and also cause irreversible vascular lesions. On the other hand, representative short-term effects of metabolic factors on cognitive dysfunction occur due to hypoglycemia or hyperglycemia. Non-genetic risk factors also modify the pathological manifestations of AD in the long-term. Therefore, vascular and metabolic factors contribute to aggravation of cognitive dysfunction in AD through short-term and long-term effects. β-amyloid could be involved in both vascular and metabolic components. It might be beneficial to support treatment in AD patients by appropriate therapeutic management of non-genetic risk factors, considering the contributions of these four elements to the manifestation of cognitive dysfunction in individual patients, though all components are not always present. It should be clarified how these four components interact with each other. To answer this question, a clinical prospective study that follows up clinical features with respect to these four components: (1) functional MRI or SPECT for cerebrovascular reactivity, (2) MRI for ischemic lesions and atrophy, (3) clinical episodes of hypoglycemia and hyperglycemia, (4) amyloid-PET and tau-PET for pathological features of AD, would be required. PMID:24204343

  13. First myocardial infarction in patients of Indian subcontinent and European origin: comparison of risk factors, management, and long term outcome.

    PubMed Central

    Shaukat, N.; Lear, J.; Lowy, A.; Fletcher, S.; de Bono, D. P.; Woods, K. L.

    1997-01-01

    OBJECTIVE: To compare long term outcome after first myocardial infarction among British patients originating from the Indian subcontinent and from Europe. DESIGN: Matched pairs study. SETTING: Coronary care unit in central Leicester. SUBJECTS: 238 pairs of patients admitted during 1987-93 matched for age (within 2 years), sex, date of admission (within 3 months), type of infarction (Q/non-Q), and site of infarction. MAIN OUTCOME MEASURES: Incidence of angina, reinfarction, or death during follow up of 1-7 years. RESULTS: Patients of Indian subcontinent origin had a higher prevalence of diabetes (35% v 9% in patients of European origin, P < 0.001), lower prevalence of smoking (39% v 63%, P < 0.001), longer median delay from symptom onset to admission (5 hours v 3 hours, P < 0.01), and lower use of thrombolysis (50% v 66%, P < 0.001). During long term follow up (median 39 months), mortality was higher in patients of Indian subcontinent origin (unadjusted hazard ratio = 2.1, 95% confidence interval 1.3 to 3.4, P = 0.002). After adjustment for smoking, history of diabetes, and thrombolysis the estimated hazard ratio fell slightly to 2.0 (1.1 to 3.6, P = 0.02). Patients of Indian subcontinent origin had almost twice the incidence of angina (54% v 29%; P < 0.001) and almost three times the risk of reinfarction during follow up (34% v 12.5% at 3 years, P < 0.001). The unadjusted hazard ratio for reinfarction in patients of Indian subcontinent origin was 2.8 (1.8 to 4.4, P < 0.001). Adjustment for smoking, history of diabetes, and thrombolysis made little difference to the hazard ratio. Coronary angiography was performed with similar frequency in the two groups; triple vessel disease was the commonest finding in patients of Indian subcontinent origin and single vessel disease the commonest in Europeans (P < 0.001). CONCLUSIONS: Patients of Indian subcontinent origin are at substantially higher risk of mortality and of further coronary events than Europeans after first

  14. Cultivar and Tree Density As Key Factors in the Long-Term Performance of Super High-Density Olive Orchards

    PubMed Central

    Díez, Concepción M.; Moral, Juan; Cabello, Diego; Morello, Pablo; Rallo, Luis; Barranco, Diego

    2016-01-01

    Super high-density (SHD) olive orchards are rapidly expanding since the first plantation was set up in Spain in the 1990s. Because there are no long-term studies characterizing these systems, it is unknown if densities above a certain threshold could trigger competition among fully-grown trees, compromising their development. Over 14 years we have evaluated the performance of the major olive cultivars currently planted in SHD systems (“Arbequina,” Arbequina IRTA-i·18, “Arbosana,” “Fs-17,” and “Koroneiki”) and nine SHD designs ranging from 780 to 2254 trees ha−1 for the cultivar “Arbequina.” Remarkably, the accumulated fruit and oil production of the five cultivars increased linearly over time. Our data indicated the favorable long-term performance of the evaluated cultivars with an average annual oil production of 2.3 t ha−1. Only “Fs-17” did not perform well to the SHD system in our conditions and it yielded about half (1.2 t ha−1) of the other cultivars. In the density trial for “Arbequina,” both fruit and oil accumulated production increased over time as a function of tree density. Thus, the accumulated oil yield ranged from 16.1 t ha−1 for the lowest density (780 trees ha−1) to 29.9 t ha−1 for the highest (2254 trees ha−1). In addition, we note that the accumulated production per surface unit showed a better correlation with the hedgerow length than the tree density. Thus, the current planting designs of SHD olive orchards can be further improved taking this parameter into account. Despite observations that some irregular patterns of crop distribution have arisen, our olive hedgerows are still fully productive after 14 years of planting. This result contradicts previous experiences that showed declines in production 7 or 8 years after planting due to high vigor, shading, and limited ventilation. PMID:27602035

  15. Acute and long-term genotoxicity of deltamethrin to insulin-like growth factors and growth hormone in rainbow trout.

    PubMed

    Aksakal, Ercüment; Ceyhun, Saltuk Buğrahan; Erdoğan, Orhan; Ekinci, Deniz

    2010-11-01

    We report here the acute and long-term influences of deltamethrin on the expression of IGF-I, IGF-II and GH-I in rainbow trout muscles. We treated rainbow trouts with different concentrations of deltamethrin (0.25 microg/L, 1 microg/L and 2.5 microg/L) and observed the alterations in mRNA expression levels of IGF-I, IGF-II and GH-I at different time intervals (at 6th, 12th, 24th, 48th, 72nd hours and 30th day). The mRNA levels significantly decreased with increasing deltamethrin concentrations for acute administration. Interestingly, a significant recovery in GH-I expression was seen after the 72nd hour up to 30th day while no significant differences were observed for IGF-I and IGF-II between the same time intervals. Here we demonstrate that deltamethrin exposure decreases the expression of IGF-I, IGF-II and GH-I in rainbow trout which might cause undesirable outcomes not only in growth, but also in development and reproduction. PMID:20647053

  16. Immunohistochemical Expression of Platelet-Derived Growth Factor Receptors in Ovarian Cancer Patients with Long-Term Follow-Up

    PubMed Central

    Madsen, Christine Vestergaard; Dahl Steffensen, Karina; Waldstrøm, Marianne; Jakobsen, Anders

    2012-01-01

    Introduction. The well-documented role of the PDGF system in tumor growth and angiogenesis has prompted the development of new biological agents targeting the PDGF system. The aim of the present study was to analyze the expression of the PDGF-receptors in ovarian cancer and to investigate its relation to histopathological parameters and long-term overall survival. Methods. The immunohistochemical expression of PDGFR-α and PDGFR-β was investigated in tumor and stromal cells in 170 patients with histologically verified epithelial ovarian cancer. Results. Almost half of the tumor specimens showed high expression of PDGFR-α and PDGFR-β in tumor cells (43% and 41%) and in stromal compartments (32% and 44%). There was a significant association between high expression of PDGFR-α and high expression of PDGFR-β in both tumor and stromal cells. Coexpression of PDGFR-α and PDGFR-β in stromal cells was seen more often in serous adenocarcinomas than in nonserous adenocarcinomas. No clear correlation between PDGFR expression and longterm overall survival or clinical parameters was found. Conclusions. PDGFR-α and PDGFR-β were expressed in a subset of ovarian carcinomas but did not show significant prognostic importance in this material. PMID:23094199

  17. Long-term functionality of rural water services in developing countries: a system dynamics approach to understanding the dynamic interaction of factors.

    PubMed

    Walters, Jeffrey P; Javernick-Will, Amy N

    2015-04-21

    Research has shown that sustainability of rural water infrastructure in developing countries is largely affected by the dynamic and systemic interactions of technical, social, financial, institutional, and environmental factors that can lead to premature water system failure. This research employs system dynamics modeling, which uses feedback mechanisms to understand how these factors interact dynamically to influence long-term rural water system functionality. To do this, the research first identified and aggregated key factors from the literature, then asked water sector experts to indicate the polarity and strength between factors through Delphi and cross impact survey questionnaires, and finally used system dynamics modeling to identify and prioritize feedback mechanisms. The resulting model identified 101 feedback mechanisms that were dominated primarily by three- and four-factor mechanisms that contained some combination of the factors: Water System Functionality, Community, Financial, Government, Management, and Technology, implying these factors were the most influential on long-term functionality. These feedback mechanisms were then scored and prioritized, with the most dominant feedback mechanism identified as Water System Functionality-Community-Finance-Management. This study showcases a way for practitioners to better understand the complexities inherent in rural water development using expert opinion and indicates the need for future research in rural water service sustainability that investigates the dynamic interaction of factors in different contexts. PMID:25775082

  18. [Long-term toxicity after therapy for testicular cancer with special focus on sexual disorders].

    PubMed

    Oldenburg, J; Fosså, S D

    2009-04-01

    Due to cisplatin-based chemotherapy, the survival rate of testicular cancer patients approaches 90%. Chemo- or radiotherapy may cause long-term complications, e.g. cardiovascular disease, secondary cancers and reduced fertility. Sperm cryopreservation is recommended depending on the extent of therapy and should be performed before orchiectomy. Furthermore, patients should be informed about long-term complications and their possible reduction by optimizing the risk factor profile. PMID:19234684

  19. Factors associated with long-term survival in dogs undergoing liver lobectomy as treatment for liver tumors

    PubMed Central

    Kinsey, Jessica R.; Gilson, Stephen D.; Hauptman, Joe; Mehler, Steve J.; May, Lauren R.

    2015-01-01

    The objectives of the study were to describe clinicopathologic findings in dogs that underwent surgical treatment of liver tumors and to define outcome-associated variables in this canine population. Medical records of 118 dogs that underwent liver lobectomy were reviewed. Variables were assessed via univariate and multivariate Cox regression analyses. Hazard ratios, median survival times (MSTs), and Kaplan-Meier Survival curves (KMSCs) were created for significant variables. Of the dogs with surgically addressed hepatic tumors, 93% survived to discharge. The MST was not reached. Lethargic dogs had a mortality risk 10.2 times that of non-lethargic dogs. Non-tachypneic dogs had a mortality risk 4.3 times that of tachypneic dogs. Dogs that experienced anesthetic complications had a mortality risk 100 times that of dogs that did not. We conclude that the prognosis associated with liver tumors is good. Lethargy, respiratory rate, and anesthetic complications were associated with outcome. PMID:26028682

  20. Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

    PubMed Central

    2013-01-01

    Background Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection. Methods A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia. Results 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02). Conclusions This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made. PMID:23705825

  1. Cell contact as an independent factor modulating cardiac myocyte hypertrophy and survival in long-term primary culture

    NASA Technical Reports Server (NTRS)

    Clark, W. A.; Decker, M. L.; Behnke-Barclay, M.; Janes, D. M.; Decker, R. S.

    1998-01-01

    Cardiac myocytes maintained in cell culture develop hypertrophy both in response to mechanical loading as well as to receptor-mediated signaling mechanisms. However, it has been shown that the hypertrophic response to these stimuli may be modulated through effects of intercellular contact achieved by maintaining cells at different plating densities. In this study, we show that the myocyte plating density affects not only the hypertrophic response and features of the differentiated phenotype of isolated adult myocytes, but also plays a significant role influencing myocyte survival in vitro. The native rod-shaped phenotype of freshly isolated adult myocytes persists in an environment which minimizes myocyte attachment and spreading on the substratum. However, these conditions are not optimal for long-term maintenance of cultured adult cardiac myocytes. Conditions which promote myocyte attachment and spreading on the substratum, on the other hand, also promote the re-establishment of new intercellular contacts between myocytes. These contacts appear to play a significant role in the development of spontaneous activity, which enhances the redevelopment of highly differentiated contractile, junctional, and sarcoplasmic reticulum structures in the cultured adult cardiomyocyte. Although it has previously been shown that adult cardiac myocytes are typically quiescent in culture, the addition of beta-adrenergic agonists stimulates beating and myocyte hypertrophy, and thereby serves to increase the level of intercellular contact as well. However, in densely-plated cultures with intrinsically high levels of intercellular contact, spontaneous contractile activity develops without the addition of beta-adrenergic agonists. In this study, we compare the function, morphology, and natural history of adult feline cardiomyocytes which have been maintained in cultures with different levels of intercellular contact, with and without the addition of beta-adrenergic agonists

  2. Environmental factors associated with long-term changes in chlorophyll-a concentration in the Amazon floodplain

    NASA Astrophysics Data System (ADS)

    Alcântara, E.; Novo, E. M.; Barbosa, C. F.; Bonnet, M.-P.; Stech, J.; Ometto, J. P.

    2011-04-01

    Long-term environmental time series of continuously collected data are fundamental to identify and classify pulses and determine their role in aquatic systems. This paper presents in situ daily mean chlorophyll-a concentration time series, key information for the current understanding of carbon fluxes in and out of the Amazonian floodplain system. This paper also investigates how seasonal fluctuations in water level affect the relationship between chlorophyll-a concentration and some of its controlling limnological (water level, water surface temperature, pH and turbidity) and meteorological (wind intensity, relative humidity and short wave radiation) variables provided by an automatic monitoring system (Integrated System for Environmental Monitoring-SIMA) deployed at Curai Lake. The data are collected in preprogrammed time interval (1 h) and are transmitted by satellite in quasi-real time for any user in a range of 2500 km from the acquisition point. We used Pearson correlation to determine the quantitative relationship between chlorophyll-a time series and others environmental parameters. Fourier power spectrum analyses were applied to identify periods of high variability in chlorophyll-a time series and wavelet power spectrum analyses helped to characterize their time-frequency structure. To further investigate the relationship between chlorophyll-a and the statistically significant variable highlighted by Pearson's correlation, the set of time series was submitted to cross wavelet analysis. The time series of chlorophyll-a shows two high peaks (47 μg L-1 and 53.30 μg L-1) of concentration during a year: first during the rising water and second during the low water level. A small peak was observed during the high water level (10 μg L-1). For the most part of rising, high and receding water level, the chlorophyll-a concentration is often low (from 2.20 μg L-1 to 9.10 μg L-1). chlorophyll-a concentration displays periodicities ranging from 2-60 days, with a

  3. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration

    PubMed Central

    2016-01-01

    Background We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. Methods We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. Results The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant

  4. The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience.

    PubMed

    Băjenaru, O; Ene, A; Popescu, B O; Szász, J A; Sabău, M; Mureşan, D F; Perju-Dumbrava, L; Popescu, C D; Constantinescu, A; Buraga, I; Simu, M

    2016-04-01

    Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson's disease (PD). Continuous administration of levodopa-carbidopa intestinal gel (LCIG-Duodopa(®), Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009-2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients' QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The "on" period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD. PMID:26699635

  5. Climate Factors Contributing to Streamflow Inputs and Extreme Water-level Deviations from Long-term Averages for Lakes Superior and Michigan-Huron

    NASA Astrophysics Data System (ADS)

    Anderson, M. T.; Stamm, J. F.

    2014-12-01

    The Great Lakes are a highly valued freshwater resource of the United States and Canada. The Lakes are the focus of a science-based restoration program, known as the Great Lakes Restoration Initiative (GLRI). Physical and chemical factors, such as inflows and nutrient loads to the Great Lakes can affect ecosystem function, contribute to the spread of invasive species and increase the occurrence of harmful algal blooms. Since about 1999, water levels in Lakes Superior and Michigan-Huron have been at or below the long-term average (1918 to present). Analyses of streamflow trends for the period 1960 to 2012 in watersheds draining into Lakes Superior and Michigan-Huron showed a long-term decline in average inflows, which helps to explain the persistently below-average lake levels. Recent climatic conditions of October 2013 to August 2014 have contributed to a rapid rise in lake levels, most notably in Lake Superior. Lake Superior recently reached an elevation of 602.56 feet above sea level in August 2014, which is the highest level in 17 years. Coincident with this recovery was the development of a large algal bloom in Lake Erie in August of 2014 that shut down the Toledo, Ohio municipal water supply. These anomalous, extreme deviations from long-term average lake levels will be examined to better understand the forcing factors that contributed to changes in inflow volumes and lake-levels. Particular focus will be given to the climatology of years when changes in lake levels are most pronounced, such as; the measured lake-level declines during 1964-1965 and 1998-2000; and lake-level rises during 1973-1974, 1987-1989, and 2013-2014. The climatology of years with periods of algal blooms will also be examined such as, 2003, 2008, 2011 and 2014.

  6. Long-Term Relationships: the Complicated Interplay between the Host and the Developmental Stages of Toxoplasma gondii during Acute and Chronic Infections.

    PubMed

    Pittman, Kelly J; Knoll, Laura J

    2015-12-01

    Toxoplasma gondii represents one of the most common parasitic infections in the world. The asexual cycle can occur within any warm-blooded animal, but the sexual cycle is restricted to the feline intestinal epithelium. T. gondii is acquired through consumption of tissue cysts in undercooked meat as well as food and water contaminated with oocysts. Once ingested, it differentiates into a rapidly replicating asexual form and disseminates throughout the body during acute infection. After stimulation of the host immune response, T. gondii differentiates into a slow-growing, asexual cyst form that is the hallmark of chronic infection. One-third of the human population is chronically infected with T. gondii cysts, which can reactivate and are especially dangerous to individuals with reduced immune surveillance. Serious complications can also occur in healthy individuals if infected with certain T. gondii strains or if infection is acquired congenitally. No drugs are available to clear the cyst form during the chronic stages of infection. This therapeutic gap is due in part to an incomplete understanding of both host and pathogen responses during the progression of T. gondii infection. While many individual aspects of T. gondii infection are well understood, viewing the interconnections between host and parasite during acute and chronic infection may lead to better approaches for future treatment. The aim of this review is to provide an overview of what is known and unknown about the complex relationship between the host and parasite during the progression of T. gondii infection, with the ultimate goal of bridging these events. PMID:26335719

  7. Factors determining long-term outcomes of hepatocellular carcinoma within the Milan criteria: liver transplantation versus locoregional therapy: A retrospective cohort study.

    PubMed

    Kim, Jung Hee; Sinn, Dong Hyun; Gwak, Geum-Youn; Choi, Gyu-Seong; Kim, Jong Man; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Ki Yeon; Kim, Kyunga; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

    2016-08-01

    Patients with hepatocellular carcinoma (HCC) satisfying the Milan criteria are candidates for liver transplantation (LT), but locoregional therapies could be another options for them.A total of 1859 treatment-naïve HCC patients fulfilling the Milan criteria were analyzed. Survival tree analysis was performed to generate survival nodes with similar survival risks in 1729 non-LT group, and compared with the survival of 130 patients who received LT.Among patients who did not receive LT, survival tree analysis classified patients into 6 nodes according to Child-Pugh (CP) score, serum alphafetoprotein (AFP) levels, tumor size, and age, with different mortality risks (5-year survival rate of 87.3%, 77.5%, 65.8%, 64.7%, 44.0%, and 28.7% for nodes 1-6, respectively; P < 0.001). The overall survival of patients in nodes 1 (CP score 5 with AFP levels <5 ng/mL) and 2 (CP score 5 with maximal tumor size <2.5 cm) were comparable with that of patients who received LT (both P > 0.05), but the survival rates of patients in nodes 3 to 6 were worse than that of LT (P < 0.05 for all). In each survival node, survival differed slightly according to initial treatment modality for patients who did not receive LT. For patients who received LT, tumor stage at the time of LT was associated with long-term outcome.Certain groups of non-LT patients showed survival rates that were similar to the survival rates of LT patients. CP score, AFP levels, tumor size, and age were baseline factors that can help estimate the long-term outcomes of non-LT treatment. In addition, tumor stage at the time of LT and specific initial treatment modality in non-LT patients affected the long-term outcomes. These factors can help estimate the long-term outcomes of HCC patients diagnosed within the Milan criteria. PMID:27583916

  8. Activation of the Transcription Factor NF-[Kappa]B by Retrieval Is Required for Long-Term Memory Reconsolidation

    ERIC Educational Resources Information Center

    Maldonado, Hector; Romano, Arturo; Merlo, Emiliano; Freudenthal, Ramiro

    2005-01-01

    Several studies support that stored memories undergo a new period of consolidation after retrieval. It is not known whether this process, termed reconsolidation, requires the same transcriptional mechanisms involved in consolidation. Increasing evidence supports the participation of the transcription factor NF-[Kappa]B in memory. This was…

  9. Four-year weight losses in the look AHEAD study: factors associated with long-term success

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This report provides the year 4 weight loss results of the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with success. 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care gr...

  10. Predictive Factors Affecting the Short Term and Long Term Exodrift in Patients with Intermittent Exotropia after Bilateral Rectus Muscle Recession and Its Effect on Surgical Outcome

    PubMed Central

    Yam, Jason C. S.; Chong, Gabriela S. L.; Wu, Patrick K. W.; Wong, Ursula S. F.; Chan, Clement W. N.; Ko, Simon T. C.

    2014-01-01

    Purpose. To determine the predictive factors that affect short term and long term postoperative drift in intermittent exotropia after bilateral lateral rectus recession and to evaluate its effect on surgical outcome. Methods. Retrospective review of 203 patients with diagnosis of intermittent exotropia, who had surgical corrections with more than 3 years of followup. Different preoperative parameters were obtained and evaluated using Pearson's correlation analysis. Results. The proportion of exodrift increased from 62% at 6 weeks to 84% at 3 years postoperatively. The postoperative drift was 4.3 ± 8.1 PD at 6 weeks, 5.8 ± 8.4 PD at 6 months, 7.2 ± 8.3 PD at 1 year, 7.4 ± 8.4 PD at 2 years, and 7.7 ± 8.5 PD at 3 years. Preoperative deviation and initial overcorrection were significant factors affecting the postoperative drift at 3 years (r = 0.177, P = 0.011, r = −0.349, and P < 0.001, resp.). Conclusions. Postoperative exodrift along three years occurs in a majority of patients after bilateral lateral rectus recession for intermittent exotropia. The long term surgical success is significantly affected by this postoperative exodrift. A larger preoperative deviation and a larger initial overcorrection are associated with a larger early and late postoperative exodrift. PMID:25093170

  11. Adeno-associated virus 2-mediated antiangiogenic cancer gene therapy: long-term efficacy of a vector encoding angiostatin and endostatin over vectors encoding a single factor.

    PubMed

    Ponnazhagan, Selvarangan; Mahendra, Gandham; Kumar, Sanjay; Shaw, Denise R; Stockard, Cecil R; Grizzle, William E; Meleth, Sreelatha

    2004-03-01

    Angiogenesis is characteristic of solid tumor growth and a surrogate marker for metastasis in many human cancers. Inhibition of tumor angiogenesis using antiangiogenic drugs and gene transfer approaches has suggested the potential of this form of therapy in controlling tumor growth. However, for long-term tumor-free survival by antiangiogenic therapy, the factors controlling tumor neovasculature need to be systemically maintained at stable therapeutic levels. Here we show sustained expression of the antiangiogenic factors angiostatin and endostatin as secretory proteins by recombinant adeno-associated virus 2 (rAAV)-mediated gene transfer. Both vectors provided significant protective efficacy in a mouse tumor xenograft model. Stable transgene persistence and systemic levels of both angiostatin and endostatin were confirmed by in situ hybridization of the vector-injected tissues and by serum ELISA measurements, respectively. Whereas treatment with rAAV containing either endostatin or angiostatin alone resulted in moderate to significant protection, the combination of endostatin and angiostatin gene transfer from a single vector resulted in a complete protection. These data suggest that AAV-mediated long-term expression of both endostatin and angiostatin may have clinical utility against recurrence of cancers after primary therapies and may represent rational adjuvant therapies in combination with radiation or chemotherapy. PMID:14996740

  12. A long-term study of the effects of celiprolol on blood pressure and lipid-associated risk factors.

    PubMed

    Herrmann, J M; Mayer, E O

    1988-11-01

    In a 12-month study of 12 patients with essential hypertension treated with once-daily celiprolol, 200 mg, mean supine blood pressure was reduced from 162/102 to 134/84 mm Hg (p less than 0.005)and standing pressures from 155/101 to 134/88 mm Hg (p less than 0.05). Similarly, heart rate fell from 83 to 71 beats/min in the supine position and from 90 to 79 beats/min in the standing position. Serum cholesterol level also fell from 5.35 to 4.78 mmol/L (p less than 0.01) and was accompanied by a nonsignificant loss of body weight. Lipid electrophoresis showed a nonsignificant increase in the high-density lipid fraction, from 1.2 to 1.7 mmol/L, and a significant decrease in the low-density lipid fraction, from 3.4 to 2.7 mmol/L (p less than 0.01). Serum triglyceride levels also decreased from 1.85 to 1.37 mmol/L (p less than 0.02), and low-density lipid-high-density lipid ratio fell from 3.29 to 2.03 (p less than 0.02). There was an unexpected reduction in serum fibrinogen levels, from 288 to 253 mg/dl (p less than 0.01). Aside from a slight reduction in the fasting blood glucose, there were no other significant changes in the urine or blood parameters, and no adverse drug effects occurred. It is likely that celiprolol's effect in reducing fibrinogen levels may minimize the increase in blood viscosity associated with the hypertensive state, whereas its effects on fibrinogen may herald a reduction in hypertensive complications such as thrombosis or retinal "cotton wool exudates." This warrants further investigation." PMID:2903652

  13. A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

    PubMed Central

    2011-01-01

    Background Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. Methods We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively. Results Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection. Conclusions Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms. PMID:22152759

  14. Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.

    PubMed

    Boockvar, Kenneth S; Teresi, Jeanne A; Inouye, Sharon K

    2016-05-01

    Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs. PMID:27160212

  15. Impact of combined pulmonary fibrosis and emphysema on surgical complications and long-term survival in patients undergoing surgery for non-small-cell lung cancer

    PubMed Central

    Hata, Atsushi; Sekine, Yasuo; Kota, Ohashi; Koh, Eitetsu; Yoshino, Ichiro

    2016-01-01

    Purpose The outcome of radical surgery for lung cancer was investigated in patients with combined pulmonary fibrosis and emphysema (CPFE). Methods A retrospective chart review involved 250 patients with lung cancer who underwent pulmonary resection at Tokyo Women’s Medical University Yachiyo Medical Center between 2008 and 2012. Based on the status of nontumor-bearing lung evaluated by preoperative computed tomography (CT), the patients were divided into normal, emphysema, interstitial pneumonia (IP), and CPFE groups, and their clinical characteristics and surgical outcome were analyzed. Results The normal, emphysema, IP, and CPFE groups comprised 124 (49.6%), 108 (43.2%), seven (2.8%), and eleven (4.4%) patients, respectively. The 5-year survival rate of the CPFE group (18.7%) was significantly lower than that of the normal (77.5%) and emphysema groups (67.1%) (P<0.0001 and P=0.0027, respectively) but equivalent to that of the IP group (44.4%) (P=0.2928). In a subset analysis of cancer stage, the 5-year overall survival rate of the CPFE group in stage I (n=8, 21.4%) was also lower than that of the normal group and emphysema group in stage I (n=91, 84.9% and n=70, 81.1%; P<0.0001 and P<0.0001, respectively). During entire observation period, the CPFE group was more likely to die of respiratory failure (27.2%) compared with the normal and emphysema groups (P<0.0001). Multivariate analysis of prognostic factors using Cox proportional hazard model identified CPFE as an independent risk factor (P=0.009). Conclusion CPFE patients have a poorer prognosis than those with emphysema alone or with normal lung on CT finding. The intensive evaluation of preoperative CT images is important, and radical surgery for lung cancer should be decided carefully when patients concomitantly harbor CPFE, because of unfavorable prognosis. PMID:27354784

  16. Factors controlling the long-term temporal and spatial patterns of nitrate-nitrogen export in a dairy farming watershed.

    PubMed

    Jiang, Rui; Wang, Chun-ying; Hatano, Ryusuke; Kuramochi, Kanta; Hayakawa, Atsushi; Woli, Krishna P

    2015-04-01

    It is difficult to investigate the factors that control the riverine nitrate-nitrogen (NO3--N) export in a watershed which gains or losses groundwater. To control the NO3--N contamination in these watersheds, it is necessary to investigate the factors that are related to the export of NO3--N that is only produced by the watershed itself. This study was conducted in the Shibetsu watershed located in eastern Hokkaido, Japan, which gains external groundwater contribution (EXT) and 34% of the annual NO3--N loading occurs through EXT. The riverine NO3--N exports from 1980 to 2009 were simulated by the SWAT model, and the factors controlling the temporal and spatial patterns of NO3--N exports were investigated without considering the EXT. The results show that hydrological events control NO3--N export at the seasonal scale, while the hydrological and biogeochemical processes are likely to control NO3--N export at the annual scale. There was an integrated effect among the land use, topography, and soil type related to denitrification process, that regulated the spatial patterns of NO3--N export. The spatial distribution of NO3--N export from hydrologic response units (HRUs) identified the agricultural areas with surplus N that are vulnerable to nitrate contamination. A new standard for the N fertilizer application rate including manure application should be given to control riverine NO3--N export. This study demonstrates that applying the SWAT model is an appropriate method to determine the temporal and spatial patterns of NO3--N export from the watershed which includes EXT and to identify the crucial pollution areas within a watershed in which the management practices can be improved to more effectively control NO3--N export to water bodies. PMID:25805369

  17. Long-Term Outcome and Prognostic Factors for Adenocarcinoma/Adenosquamous Carcinoma of Cervix After Definitive Radiotherapy

    SciTech Connect

    Huang, Yi-Ting; Wang, Chun-Chieh; Tsai, Chien-Sheng; Lai, Chyong-Huey; Chang, Ting-Chang; Chou, Hung-Hsueh; Hsueh, Swei; Chen, Chien-Kuang; Lee, Steve P.; Hong, Ji-Hong

    2011-06-01

    Purpose: To study the outcomes of patients with adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix primarily treated with radiotherapy (RT), identify the prognostic factors, and evaluate the efficacy of concurrent chemoradiotherapy (CCRT) or salvage surgery. Methods and Materials: A total of 148 patients with Stage I-IVA AC/ASC of cervix after full-course definitive RT were included. Of the 148 patients, 77% had advanced stage disease. Treatment failure was categorized as either distant or local failure. Local failure was further separated into persistent tumor or local relapse after complete remission. The effectiveness of CCRT with cisplatin and/or paclitaxel was examined, and the surgical salvage rate for local failure was reviewed. Results: The 5-year relapse-free survival rate was 68%, 38%, 49%, 30%, and 0% for those with Stage IB/IIA nonbulky, IB/IIA bulky, IIB, III, and IVA disease, respectively, and appeared inferior to that of those with squamous cell carcinoma of the cervix treated using the same RT protocol. Incomplete tumor regression after RT, a low hemoglobin level, and positive lymph node metastasis were independent poor prognostic factors for relapse-free survival. CCRT with weekly cisplatinum did not improve the outcome for our AC/ASC patients. Salvage surgery rescued 30% of patients with persistent disease. Conclusion: Patients with AC/ASC of the cervix primarily treated with RT had inferior outcomes compared to those with squamous cell carcinoma. Incomplete tumor regression after RT was the most important prognostic factor for local failure. Salvage surgery for patients with persistent tumor should be encouraged for selected patients. Our results did not demonstrate a benefit of CCRT with cisplatin for this disease.

  18. Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

    PubMed

    Hubbard, Rebecca A; O'Meara, Ellen S; Henderson, Louise M; Hill, Deirdre; Braithwaite, Dejana; Haas, Jennifer S; Lee, Christoph I; Sprague, Brian L; Alford-Teaster, Jennifer; Tosteson, Anna N A; Wernli, Karen J; Onega, Tracy

    2016-08-01

    In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66-75years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005-2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66-70years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65-2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11-1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31-1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24-1.66). Women aged 71-75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence. PMID:27261409

  19. Long-term trends of surface ozone and its influencing factors at the Mt Waliguan GAW station, China - Part 1: Overall trends and characteristics

    NASA Astrophysics Data System (ADS)

    Xu, Wanyun; Lin, Weili; Xu, Xiaobin; Tang, Jie; Huang, Jianqing; Wu, Hao; Zhang, Xiaochun

    2016-05-01

    Tropospheric ozone is an important atmospheric oxidant, greenhouse gas and atmospheric pollutant at the same time. The oxidation capacity of the atmosphere, climate, human and vegetation health can be impacted by the increase of the ozone level. Therefore, long-term determination of trends of baseline ozone is highly needed information for environmental and climate change assessment. So far, studies on the long-term trends of ozone at representative sites are mainly available for European and North American sites. Similar studies are lacking for China and many other developing countries. Measurements of surface ozone were carried out at a baseline Global Atmospheric Watch (GAW) station in the north-eastern Tibetan Plateau region (Mt Waliguan, 36°17' N, 100°54' E, 3816 m a.s.l.) for the period of 1994 to 2013. To uncover the variation characteristics, long-term trends and influencing factors of surface ozone at this remote site in western China, a two-part study has been carried out, with this part focusing on the overall characteristics of diurnal, seasonal and long-term variations and the trends of surface ozone. To obtain reliable ozone trends, we performed the Mann-Kendall trend test and the Hilbert-Huang transform (HHT) analysis on the ozone data. Our results confirm that the mountain-valley breeze plays an important role in the diurnal cycle of surface ozone at Waliguan, resulting in higher ozone values during the night and lower ones during the day, as was previously reported. Systematic diurnal and seasonal variations were found in mountain-valley breezes at the site, which were used in defining season-dependent daytime and nighttime periods for trend calculations. Significant positive trends in surface ozone were detected for both daytime (0.24 ± 0.16 ppbv year-1) and nighttime (0.28 ± 0.17 ppbv year-1). The largest nighttime increasing rate occurred in autumn (0.29 ± 0.11 ppbv year-1), followed by spring (0.24 ± 0.12 ppbv year-1), summer (0.22 ± 0

  20. [Long-term survival and prognostic factors in multiple myeloma treated with conventional chemotherapy. Report of 109 cases].

    PubMed

    Ben Abid, H; Meddeb, B; Ben Abdallah, M; Bel Hadj Ali, Z; Hafsia, R; Ben Lakhal, R; Gouider, E; Aissaoui, L; Landoulsi, I; ben Abdeladhim, A; Hafsia, A

    2000-12-01

    Our study is retrospective. We report the results of conventional chemotherapy ins previosly untreated patients with myeloma. Survival and prognostic factors were analysed in 109 patients diagnosed from 1983 to 1992. The median age was 65 years, 87 patients (80%) were including in the stage III according the Durie Salmon staging system. The median survival time was 27 months and 10 years survival rate is 3.66%. In the univariate analysis, two prognostic variables were retained namely the hemoglobin and creatinine level. The study suggest that conventional therapy is a good treatment for old patients. However, patients younger than 55 years, must benefit from intensive chemotherapy supported by autologous bone marrow, pheripheral blood stem cells, or allogenic bone marrow transplantation. A considerable encrace in duration of remission and survival is possible. PMID:11155374

  1. Induction of long-term potentiation and depression is reflected by corresponding changes in secretion of endogenous brain-derived neurotrophic factor

    PubMed Central

    Aicardi, Giorgio; Argilli, Emanuela; Cappello, Silvia; Santi, Spartaco; Riccio, Massimo; Thoenen, Hans; Canossa, Marco

    2004-01-01

    Neurotrophins play an important role in modulating activity-dependent neuronal plasticity. In particular, threshold levels of brain-derived neurotrophic factor (BDNF) are required to induce long-term potentiation (LTP) in acute hippocampal slices. Conversely, the administration of exogenous BDNF prevents the induction of long-term depression (LTD) in the visual cortex. A long-standing missing link in the analysis of this modulatory role of BDNF was the determination of the time-course of endogenous BDNF secretion in the same organotypic preparation in which LTP and LTD are elicited. Here, we fulfilled this requirement in slices of perirhinal cortex. Classical theta-burst stimulation patterns evoking LTP lasting >180 min elicited a large increase in BDNF secretion that persisted 5-12 min beyond the stimulation period. Weaker theta-burst stimulation patterns leading only to the initial phase of LTP (≈35 min) were accompanied by a smaller increase in BDNF secretion lasting <1 min. Sequestration of BDNF by TrkB-IgG receptor bodies prevented LTP. Low-frequency stimulations leading to LTD were accompanied by reductions in BDNF secretion that never lasted beyond the duration of the stimulation. PMID:15505222

  2. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration.

    PubMed

    Mrejen, Sarah; Jung, Jesse J; Chen, Christine; Patel, Samir N; Gallego-Pinazo, Roberto; Yannuzzi, Nicolas; Xu, Luna; Marsiglia, Marcela; Boddu, Sucharita; Freund, K Bailey

    2015-01-01

    With the advent of anti-vascular endothelial growth factor (VEGF) therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD), a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naïve NVAMD initially classified based on fluorescein angiography (FA) alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT) and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER) with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes) were followed over an average of 3.5 years (range 1-6.6) with a retention rate of 62.9%, and visual acuity significantly improved with a TER that required a mean number of 8.3 (±1.6) (± standard deviation) intravitreal anti-VEGF injections/year (range 4-13). The number of injections and the anatomic classification were independent predictors of visual acuity at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events. A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than those with other neovascular subtypes. PMID:26239682

  3. Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study

    PubMed Central

    Okoboi, Stephen; Ssali, Livingstone; Yansaneh, Aisha I; Bakanda, Celestin; Birungi, Josephine; Nantume, Sophie; Okullu, Joanne Lyavala; Sharp, Alana R; Moore, David M; Kalibala, Samuel

    2016-01-01

    Introduction As access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004. Methods Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and factors associated with attrition among HIV-positive adolescents aged 10–19 years who initiated ART at 10 TASO clinics between January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died, were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to determine the levels of retention in HIV care and the factors associated with attrition following ART initiation. Results A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV care was four years (IQR=3–6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%) had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being older (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI) 1.02–1.86), having a higher CD4 count (250+ cells/mm3) at treatment initiation (AHR=0.49, 95% CI 0.34–0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu (AHR=2.26; 95% CI 1.27–4.02) and Masindi (AHR=3.30, 95% CI 1.87–5.84) and a lower risk of attrition in Jinja (AHR=0.24, 95% CI 0.08–0.70). Having an advanced WHO clinical stage at initiation was not

  4. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study

    PubMed Central

    Holter, Jan C.; Ueland, Thor; Jenum, Pål A.; Müller, Fredrik; Brunborg, Cathrine; Frøland, Stig S.; Aukrust, Pål; Husebye, Einar; Heggelund, Lars

    2016-01-01

    Background Contributors to long-term mortality in patients with community-acquired pneumonia (CAP) remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics. Methods Two hundred and sixty-seven consecutive patients admitted in 2008–2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality. Results Of 259 hospital survivors of CAP (median age 66 years), 79 (30.5%) died over a median of 1,804 days (range 1–2,520 days). Cumulative 5-year survival rate was 72.9% (95% CI 67.4–78.4%). Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD), vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI): age (1.83 per decade, 1.47–2.28), cardiovascular disease (2.63, 1.61–4.32), COPD (2.09, 1.27–3.45), immunocompromization (1.98, 1.17–3.37), and low serum albumin level at admission (0.75 per 5g/L higher, 0.58–0.96), whereas active smoking was protective (0.32, 0.14–0.74); active smokers were younger than non-smokers (P < 0.001). Microbial etiology did not predict mortality. Conclusions Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend

  5. Low-dose total body irradiation in non-Hodgkin lymphoma: Short- and long-term toxicity and prognostic factor

    SciTech Connect

    De Neve, W.J.; Lybeert, M.L.; Meerwaldt, J.H. )

    1990-08-01

    The toxicity of low-dose total body irradiation (LTBI), the prognostic factors related to survival and relapse-free survival, and the efficacy of treatment given for relapse after LTBI were analyzed in 68 patients with non-Hodgkin lymphoma (NHL) treated at the Rotterdamsch Radiotherapeutisch Instituut. All patients received LTBI between 1973 and 1979. The patient material was heterogeneous with respect to malignancy grade, stage, age, and therapy given before or after LTBI; the unifying principle was that all patients received LTBI and had symptomatic NHL. Analysis of prognostic variables with Cox's model revealed grade (p less than 0.001) and age (p = 0.004) as predictors for survival and grade (p less than 0.001) and dose of LTBI (p = 0.056) as predictors for relapse-free survival after LTBI. No subjective toxicity was observed during or after LTBI treatment. Hematologic toxicity was dose-limiting and was increased if patients had received cytotoxic treatment before LTBI. LTBI-related hematologic toxicity was lower in patients with low-grade NHL than in those with intermediate or high-grade NHL, was limited in time, and recovered in all patients. Patients relapsing after LTBI received a variety of therapies. Response rates were high, but of short duration, especially in intermediate or high-grade NHL. Duration of response was progressively shorter after multiple relapses.

  6. Long-term survival of Borrelia burgdorferi lacking the hibernation promotion factor homolog in the unfed tick vector.

    PubMed

    Fazzino, Lisa; Tilly, Kit; Dulebohn, Daniel P; Rosa, Patricia A

    2015-12-01

    Borrelia burgdorferi, a causative agent of Lyme borreliosis, is a zoonotic pathogen that survives in nutrient-limited environments within a tick, prior to transmission to its mammalian host. Survival under these prolonged nutrient-limited conditions is thought to be similar to survival during stationary phase, which is characterized by growth cessation and decreased protein production. Multiple ribosome-associated proteins are implicated in stationary-phase survival of Escherichia coli. These proteins include hibernation-promoting factor (HPF), which dimerizes ribosomes and prevents translation of mRNA. Bioinformatic analyses indicate that B. burgdorferi harbors an hpf homolog, the bb0449 gene. BB0449 protein secondary structure modeling also predicted HPF-like structure and function. However, BB0449 protein was not localized in the ribosome-associated protein fraction of in vitro-grown B. burgdorferi. In wild-type B. burgdorferi, bb0449 transcript and BB0449 protein levels are low during various growth phases. These results are inconsistent with patterns of synthesis of HPF-like proteins in other bacterial species. In addition, two independently derived bb0449 mutants successfully completed the mouse-tick infectious cycle, indicating that bb0449 is not required for prolonged survival in the nutrient-limited environment in the unfed tick or any other stage of infection by B. burgdorferi. We suggest either that BB0449 is associated with ribosomes under specific conditions not yet identified or that BB0449 of B. burgdorferi has a function other than ribosome conformation modulation. PMID:26438790

  7. Long-Term Survival of Borrelia burgdorferi Lacking the Hibernation Promotion Factor Homolog in the Unfed Tick Vector

    PubMed Central

    Fazzino, Lisa; Dulebohn, Daniel P.

    2015-01-01

    Borrelia burgdorferi, a causative agent of Lyme borreliosis, is a zoonotic pathogen that survives in nutrient-limited environments within a tick, prior to transmission to its mammalian host. Survival under these prolonged nutrient-limited conditions is thought to be similar to survival during stationary phase, which is characterized by growth cessation and decreased protein production. Multiple ribosome-associated proteins are implicated in stationary-phase survival of Escherichia coli. These proteins include hibernation-promoting factor (HPF), which dimerizes ribosomes and prevents translation of mRNA. Bioinformatic analyses indicate that B. burgdorferi harbors an hpf homolog, the bb0449 gene. BB0449 protein secondary structure modeling also predicted HPF-like structure and function. However, BB0449 protein was not localized in the ribosome-associated protein fraction of in vitro-grown B. burgdorferi. In wild-type B. burgdorferi, bb0449 transcript and BB0449 protein levels are low during various growth phases. These results are inconsistent with patterns of synthesis of HPF-like proteins in other bacterial species. In addition, two independently derived bb0449 mutants successfully completed the mouse-tick infectious cycle, indicating that bb0449 is not required for prolonged survival in the nutrient-limited environment in the unfed tick or any other stage of infection by B. burgdorferi. We suggest either that BB0449 is associated with ribosomes under specific conditions not yet identified or that BB0449 of B. burgdorferi has a function other than ribosome conformation modulation. PMID:26438790

  8. Long-term course of anti-factor VIII antibody in patients with hemophilia A at a single center

    PubMed Central

    Joo, Sang Chun; Choi, Yong Mook

    2016-01-01

    Background Immune tolerance induction (ITI) can reduce inhibitors against factor VIII concentrates by 70-80%. In this study, we elucidated the characteristics of inhibitors and attempted to determine the proper indications and timing for ITI. Methods Subjects included hemophilia A patients registered at the Korea Hemophilia Foundation from 1991 through 2014. Inhibitors were classified as persistent and transient. Patients were classified into groups according to peak inhibitor titer: low (<2 BU/mL), moderate (2 to <5 BU/mL), high (5 to <10 BU/mL), and very high titer (≥10 BU/mL). Results Overall, 350 (21.4%) of 1,634 hemophilia A patients developed inhibitors at least once. Of these, 100 (6.1%) and 250 (15.3%) patients developed persistent and transient inhibitors, respectively. For transient inhibitors, the median peak titer was 1.0 BU/mL, persistent for median of 11.0 months (10.0, 8.0, 13.0, and 19.0 months in the low, moderate, high, and very high titer transient inhibitor groups, respectively). Overall, 95.8% (215), 72.2% (17), 52.4% (21), and 21.7% (97) of patients in the low, moderate, high, and very high titer groups became inhibitor-negative spontaneously, without ITI. Conclusion Given the spontaneous disappearance of inhibitors and high cost of ITI, it is worthwhile to postpone ITI for 11 months unless the peak inhibitor titer is greater than 10 BU/mL. PMID:27104190

  9. Estimation of long-term Ca(2+) loss through outlet flow from an agricultural watershed and the influencing factors.

    PubMed

    Zhang, Wenzhao; Yin, Chunmei; Chen, Chunlan; Chen, Anlei; Xie, Xiaoli; Fu, Xingan; Hou, Haijun; Wei, Wenxue

    2016-06-01

    Soil Ca(2+) loss from agricultural lands through surface runoff can accelerate soil acidification and render soil degradation, but the characteristics of Ca(2+) loss and influencing factors in watershed scale are unclear. This study was carried out in a watershed with various land uses in a subtropical region of China. The outlet flow was automatically monitored every 5 min all year round, and the water samples were collected twice a year from 2001 to 2011. The concentrations of Ca(2+), Mg(2+), K(+), total nitrogen (TN), and total phosphorus (TP) of water samples were measured. The dynamic losses of the nutrients through the outlet flow were estimated, and the relationships between the nutrient losses and rainfall intensity as well as antecedent soil moisture were investigated. The results showed that great variations of nutrient concentrations and losses appeared during the investigation period. The average concentrations of Ca(2+), Mg(2+), K(+), TN, and TP were 0.43, 0.08, 0.10, 0.19, and 0.003 mmol L(-1), respectively. The average Ca(2+) loss reached 1493.79 mol ha(-1) year(-1) and was several times higher than for Mg(2+), K(+), and TN, about 140 times higher than for TP. Rainfall intensity had remarkable effects on Ca(2+) concentration (P < 0.01) and loss (P < 0.05) when it reached rainstorm level (50 mm day(-1)), while a quadratic relationship was observed between antecedent soil moisture and Ca(2+) concentration only when rainfall intensity was less than 50 mm day(-1). In a word, much greater amounts of Ca(2+) were lost from the watershed, and this may be one important contributor to the increasing acidification of acidic soils in subtropical regions. PMID:26898929

  10. Functional proteomic analysis of long-term growth factor stimulation and receptor tyrosine kinase coactivation in Swiss 3T3 fibroblasts.

    PubMed

    Nagano, Kohji; Akpan, Akunna; Warnasuriya, Gayathri; Corless, Steven; Totty, Nick; Yang, Alice; Stein, Robert; Zvelebil, Marketa; Stensballe, Allan; Burlingame, Al; Waterfield, Michael; Cramer, Rainer; Timms, John F; Naaby-Hansen, Søren

    2012-12-01

    In Swiss 3T3 fibroblasts, long-term stimulation with PDGF, but not insulin-like growth factor 1 (IGF-1) or EGF, results in the establishment of an elongated migratory phenotype, characterized by the formation of retractile dendritic protrusions and absence of actin stress fibers and focal adhesion complexes. To identify receptor tyrosine kinase-specific reorganization of the Swiss 3T3 proteome during phenotypic differentiation, we compared changes in the pattern of protein synthesis and phosphorylation during long-term exposure to PDGF, IGF-1, EGF, and their combinations using 2DE-based proteomics after (35)S- and (33)P-metabolic labeling. One hundred and five differentially regulated proteins were identified by mass spectrometry and some of these extensively validated. PDGF stimulation produced the highest overall rate of protein synthesis at any given time and induced the most sustained phospho-signaling. Simultaneous activation with two or three of the growth factors revealed both synergistic and antagonistic effects on protein synthesis and expression levels with PDGF showing dominance over both IGF-1 and EGF in generating distinct proteome compositions. Using signaling pathway inhibitors, PI3K was identified as an early site for signal diversification, with sustained activity of the PI3K/AKT pathway critical for regulating late protein synthesis and phosphorylation of target proteins and required for maintaining the PDGF-dependent motile phenotype. Several proteins were identified with novel PI3K/Akt-dependent synthesis and phosphorylations including eEF2, PRS7, RACK-1, acidic calponin, NAP1L1, Hsp73, and fascin. The data also reveal induction/suppression of key F-actin and actomyosin regulators and chaperonins that enable PDGFR to direct the assembly of a motile cytoskeleton, despite simultaneous antagonistic signaling activities. Together, the study demonstrates that long-term exposure to different growth factors results in receptor tyrosine kinase