AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecuti...AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecutive group of 588patients, who had undergone total joint arthroplasty(TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding variables.RESULTS: Complete follow-up data was collected on 554 of the 588 total patients(93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age(P = 0.026) and a greater proportion of females(P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo postoperative.CONCLUSION: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.展开更多
Background: Approximately 71.1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23.7 cases per 100,000 population in 2015, with an estimated 1.75 million new H...Background: Approximately 71.1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23.7 cases per 100,000 population in 2015, with an estimated 1.75 million new HCV infections diagnosed in 2015. In Switzerland, it is estimated that 37,000 patients have chronic HCV infection. In the Southern part of Switzerland liver disease patients are mainly followed at the six outpatient clinics of Epatocentro Ticino (EPT) connected with its hub in Lugano. The aim of the study was to identify lost to follow-up patients and reconnect them to specialist care. Methods: We used the database from EPT to identify HCV positive patients, who were lost to follow-up in the years 2007-2017. We consider lost to follow-up patients who had their last visit more than 2 years before closing date of analysis. We contacted the patients on the phone or by mail. Results: Overall 1271 patients have been at EPT between 2007 and 2017;of those 74 were lost to follow-up at the time of our screening. We received an answer from 60 of them. The results we collected were that 12 (6%) have died, 31 (42%) were currently followed by the General Practitioner (GP) or a different specialist, 9 (12%) were cured from HCV infection and did not need any further visit, and 4 (5%) refused to come for a check-up visit. In total, we rescued 4 (5%) patients and follow them at the EPT. Conclusion: Our look-back study revealed that our “Hub and Spoke-approach” had a high retention rate such that only 6% of our HCV patients were lost to follow-up. The look-back effort was still useful: the number of patients to recall identifying one patient needing treatment was 19.展开更多
BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal ...BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.展开更多
AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a tota...AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.展开更多
Background:There is concern about the increasing rates of loss to follow-up(LTFU)among pre-antiretroviral therapy(pre-ART)patients in Ethiopia.Little information is available regarding the time when pre-ART patients a...Background:There is concern about the increasing rates of loss to follow-up(LTFU)among pre-antiretroviral therapy(pre-ART)patients in Ethiopia.Little information is available regarding the time when pre-ART patients are lost to follow-up in the country.This study assessed the time when LTFU occurs as well as the associated factors among adults enrolled in pre-ART care in an Ethiopian rural hospital.Methods:Data of all adult pre-ART patients enrolled at the Sheka Zonal Hospital between 2010 and 2013 were reviewed.Patients were considered lost to follow-up if they failed to keep scheduled appointments for more than 90 days.The Cox proportional hazards regression model was used to assess factors associated with time until LTFU.The Kaplan-Meier survival table was used to compare the LTFU experiences of patients,segregated by significant predictors.Results:A total of 626 pre-ART patients were followed for 319.92 person-years of observation(PYOs)from enrolment to pre-ART outcomes,with an overall LTFU rate of 55.8 per 100 PYOs.A total of 178(28.4%)pre-ART patients were lost to follow-up,93%of which occurred within the first six months.The median follow-up time was 6.13 months.The independent predictors included:not having been started on co-trimoxazole prophylaxis(adjusted hazard ratio[AHR]=1.77,95%confidence interval[CI],1.12–2.79),a baseline CD4 count of or above 350 cells/mm3(AHR=1.87,95%CI,1.02–3.45),and an undisclosed HIV status(AHR=3.04,95%CI,2.07–4.45).Conclusion:A significant proportion of pre-ART patients is lost to follow-up.Not having been started on co-trimoxazole prophylaxis,presenting to care with a baseline CD4 cell count≥350 cells/mm3,and an undisclosed HIV status were significant predictors of LTFU among pre-ART patients.Thus,close monitoring and tracking of patients during this period is highly recommended.Those patients with identified risk factors deserve special attention.展开更多
Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a succ...Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.展开更多
Clear cell sarcoma(CCS)is a rare melanocytic soft tissue sarcoma known for itspropensity to metastasize to the lymph nodes and typically has an unfavorableprognosis.Currently,surgical resection is the primary treatmen...Clear cell sarcoma(CCS)is a rare melanocytic soft tissue sarcoma known for itspropensity to metastasize to the lymph nodes and typically has an unfavorableprognosis.Currently,surgical resection is the primary treatment for localizedCCS,while radiotherapy and chemotherapy are preferred for metastatic cases.The roles of adjuvant chemotherapy,radiotherapy,and lymph node dissection arecontroversial.Although immunotherapy has emerged as a promising avenue inCCS treatment research,there are no established clinical standards for postoperativefollow-up.This editorial discusses a recent article by Liu et al,with afocus on current diagnostic modalities,treatment approaches,and the challengingprognosis associated with CCS.Our aim is to underscore the importance of longtermpatient follow-up in CCS management.展开更多
BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study pre...BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.展开更多
Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest f...Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest from scientists and practitioners, though it is recognized as one of the weakest points of EIA systems globally. Also, EIA follow-up is influenced by the context, mainly in terms of the types of projects or activities and their related impacts on the environment. Therefore, the present paper is focused on the investigation of the follow-up stage applied to the activity of seismic survey coupled with offshore oil & gas exploitation in Brazil. Research was based on a qualitative approach that included document analysis and semi-structured interviews with analysts involved in EIA processes, and sought to generate evidence of effectiveness of the EIA follow-up as conducted by the Federal Environment Agency (Ibama) in order to situate the practice of follow-up in the broader context of international best practice principles. Based on the findings, it was concluded that, due to the peculiarities of offshore seismic survey, it is necessary to promote adaptations in the procedures for monitoring impacts in order to ensure proper alignment with the principles and conceptual foundations that guide EIA practice. Specifically, the timing of the execution of the activity imposes challenges for its integration into the “conventional” cycle that has guided the monitoring of the impacts in the EIA of projects.展开更多
BACKGROUND Several studies found that early pancreatic atrophy detected by computed tomo-graphy(CT)within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis(AIP)r...BACKGROUND Several studies found that early pancreatic atrophy detected by computed tomo-graphy(CT)within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis(AIP)receiving steroid therapy;however,no long-term follow-up studies have been performed.AIM To investigate pancreatic volume(PV)changes using three dimensional(3D)-CT volumetry and their relationship with IgG4 and diabetes in patients with AIP.METHODS This retrospective study included 33 patients with type-1 AIP receiving steroid therapy.Patients were divided into diffuse(D-type)and mass-forming type(M-type)AIP.PV was determined by semi-automated 3D-CT volumetry,and changes between initial and follow-up values were calculated.The relationship between PV and serum IgG4 levels was analyzed by Spearman’s rank correlation.The PV atrophy ratio compared with the presumed normal PV at the time of last follow-up CT and its relationship with diabetes were investigated.RESULTS There were 16 D-type and 17 M-type patients with long-term follow-up(mean,95.8 months).The regression curve of mean relative PV change reduced exponentially and rapidly during the first 25 months and then more slowly in both groups.The overall cumulative pancreas re-enlargement rates at 1,3,5,7 and 10 years were 6.1%,12.2%,29.2%,47.5%and 55.0%,respectively.There was a moderate-to-very strong positive correlation(ρ≥0.4)between PV and serum IgG4 levels in nine(9/13,69.2%)patients.All 33 patients showed pancreatic atrophy(mean 59.3%)after long-term follow-up.Patients with D-type AIP had a significantly higher atrophy rate and higher incidence of diabetes than M-type patients(P<0.05).CONCLUSION PV change initially reduced exponentially and then more slowly and is considered an important factor associated with diabetes.Serum IgG4 levels were positively correlated with PV during follow-up.展开更多
In the digital age,traditional media ethics norms lack sufficient explanatory power and binding force in practice.This paper uses the“Primary School Student Lost Homework in Paris”incident as a case study to explore...In the digital age,traditional media ethics norms lack sufficient explanatory power and binding force in practice.This paper uses the“Primary School Student Lost Homework in Paris”incident as a case study to explore the ethical controversies surrounding the dissemination of this event.By adopting a hierarchical media ethics perspective,the paper dynamically examines the ethical conduct of various communicators,elucidates the ethical responsibilities of each party involved,and reveals the complexity of communication ethics in the digital age.展开更多
The microstructure and mechanical properties of Mg-10.1Gd-3.74Y-0.25Zr (mass fraction, %) alloy (GW104 alloy) cast by metal mould casting (MMC) and lost foam casting (LFC) were evaluated, respectively. It is r...The microstructure and mechanical properties of Mg-10.1Gd-3.74Y-0.25Zr (mass fraction, %) alloy (GW104 alloy) cast by metal mould casting (MMC) and lost foam casting (LFC) were evaluated, respectively. It is revealed that different forming modes do not influence the phase composition of as-cast alloy. In the as-cast specimens, the microstructures are similar and composed of α-Mg solid solution, eutectic compound of α-Mg+Mg 24 (Gd, Y) 5 and cuboid-shaped Mg 5 (Gd, Y) phase; whereas the average grain size of the alloy produced by metal mould casting is smaller than that by lost foam casting. The eutectic compound of the alloy is completely dissolved after solution treatment at 525 ℃for 6 h, while the Mg 5 (Gd, Y) phase still exists after solution treatment. After peak-ageing, the lost foam cast alloy exhibits the maximum ultimate tensile strength of 285 MPa, and metal mould cast specimen 325 MPa at room temperature, while the tensile yield strengths of them are comparable. It can be concluded that GW104 alloy cast by lost foam casting possesses similar microstructure and evidently lower mechanical strength compared with metal mould cast alloy, due to slow solidification rate and proneness to form shrinkage porosities during lost foam casting process.展开更多
BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and te...BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.展开更多
The Lost Generation is actually a group of American writers who were rebelling against what America had become by the 1900s.The Lost generation tendency and Lost generation writers are of great importance to the Ameri...The Lost Generation is actually a group of American writers who were rebelling against what America had become by the 1900s.The Lost generation tendency and Lost generation writers are of great importance to the American and world literature.This article serves as a brief introduction to the Lost generation and its significant writers.展开更多
《The Lost Garden》是美国著名华裔儿童文学作家叶祥添的自传,已被选录入美国中学世界文学教科书,从文体学的角度入手,对《The Lost Garden》的语言特征进行研析,能更深入地挖掘美籍华裔作家叶祥添的语言风格、语用意图和创作主旨。运...《The Lost Garden》是美国著名华裔儿童文学作家叶祥添的自传,已被选录入美国中学世界文学教科书,从文体学的角度入手,对《The Lost Garden》的语言特征进行研析,能更深入地挖掘美籍华裔作家叶祥添的语言风格、语用意图和创作主旨。运用文体学方法,从词汇、句子、语篇及修辞等四个不同的层面,对《The Lost Garden》的文体特征进行细致分析,通过探讨该文本语言在这四个不同层面的特征,作品的语言特色得以凸现,读者得以更走近文本,这有助于读者更深刻地理解该文本的文体风格,更准确地分析作品的人物特征及把握作者的意图,从而更加全面、正确地理解和鉴赏作品。展开更多
Porosity is thought to be severe in aluminum alloy castings produced by lost foam process due to the pyrolysis of the polystyrene foam pattern during pouring, which results in detrimental effect in mechanical property...Porosity is thought to be severe in aluminum alloy castings produced by lost foam process due to the pyrolysis of the polystyrene foam pattern during pouring, which results in detrimental effect in mechanical property. The slow solidification rate promotes the formation of gassing pin holes, and relative weakness of the thermal gradients can cause micro-shrinkage if the outline of the part complicates feeding in the lost foam casting. One of the methods to eliminate the porosity is to apply high pressure to the molten metal like an isostatic forging during solidification. Fundamental experiments were carried out to evaluate the effect of the external pressure on the porosity and mechanical properties of A356.2 alloy bar in the lost foam casting. Solidification time and porosity decreased with increasing the applied pressure during solidification. Applying external pressure was effective in decreasing the porosity and increasing the elongation of the lost foam casting.展开更多
The importance of follow-up education of college English has been obvious in recent years, but there are still many problems which need to be solved as soon as possible, such as how to carry out the follow-up educatio...The importance of follow-up education of college English has been obvious in recent years, but there are still many problems which need to be solved as soon as possible, such as how to carry out the follow-up education effectively and in what way to conduct the follow-up education and the course arrangement. The thesis hopes to solve the above problems to some extent.展开更多
文摘AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecutive group of 588patients, who had undergone total joint arthroplasty(TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding variables.RESULTS: Complete follow-up data was collected on 554 of the 588 total patients(93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age(P = 0.026) and a greater proportion of females(P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo postoperative.CONCLUSION: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.
文摘Background: Approximately 71.1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23.7 cases per 100,000 population in 2015, with an estimated 1.75 million new HCV infections diagnosed in 2015. In Switzerland, it is estimated that 37,000 patients have chronic HCV infection. In the Southern part of Switzerland liver disease patients are mainly followed at the six outpatient clinics of Epatocentro Ticino (EPT) connected with its hub in Lugano. The aim of the study was to identify lost to follow-up patients and reconnect them to specialist care. Methods: We used the database from EPT to identify HCV positive patients, who were lost to follow-up in the years 2007-2017. We consider lost to follow-up patients who had their last visit more than 2 years before closing date of analysis. We contacted the patients on the phone or by mail. Results: Overall 1271 patients have been at EPT between 2007 and 2017;of those 74 were lost to follow-up at the time of our screening. We received an answer from 60 of them. The results we collected were that 12 (6%) have died, 31 (42%) were currently followed by the General Practitioner (GP) or a different specialist, 9 (12%) were cured from HCV infection and did not need any further visit, and 4 (5%) refused to come for a check-up visit. In total, we rescued 4 (5%) patients and follow them at the EPT. Conclusion: Our look-back study revealed that our “Hub and Spoke-approach” had a high retention rate such that only 6% of our HCV patients were lost to follow-up. The look-back effort was still useful: the number of patients to recall identifying one patient needing treatment was 19.
文摘BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.
基金Supported by the Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.YNZD2201903)the Scientific Research Foundation of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.KYQD20180306)the Nursing Project of the Eye Hospital of Wenzhou Medical University(No.YNHL2201908).
文摘AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
基金We acknowledge Jimma University for financial support.We are also grateful to the staff at the Sheka Zonal Hospital.
文摘Background:There is concern about the increasing rates of loss to follow-up(LTFU)among pre-antiretroviral therapy(pre-ART)patients in Ethiopia.Little information is available regarding the time when pre-ART patients are lost to follow-up in the country.This study assessed the time when LTFU occurs as well as the associated factors among adults enrolled in pre-ART care in an Ethiopian rural hospital.Methods:Data of all adult pre-ART patients enrolled at the Sheka Zonal Hospital between 2010 and 2013 were reviewed.Patients were considered lost to follow-up if they failed to keep scheduled appointments for more than 90 days.The Cox proportional hazards regression model was used to assess factors associated with time until LTFU.The Kaplan-Meier survival table was used to compare the LTFU experiences of patients,segregated by significant predictors.Results:A total of 626 pre-ART patients were followed for 319.92 person-years of observation(PYOs)from enrolment to pre-ART outcomes,with an overall LTFU rate of 55.8 per 100 PYOs.A total of 178(28.4%)pre-ART patients were lost to follow-up,93%of which occurred within the first six months.The median follow-up time was 6.13 months.The independent predictors included:not having been started on co-trimoxazole prophylaxis(adjusted hazard ratio[AHR]=1.77,95%confidence interval[CI],1.12–2.79),a baseline CD4 count of or above 350 cells/mm3(AHR=1.87,95%CI,1.02–3.45),and an undisclosed HIV status(AHR=3.04,95%CI,2.07–4.45).Conclusion:A significant proportion of pre-ART patients is lost to follow-up.Not having been started on co-trimoxazole prophylaxis,presenting to care with a baseline CD4 cell count≥350 cells/mm3,and an undisclosed HIV status were significant predictors of LTFU among pre-ART patients.Thus,close monitoring and tracking of patients during this period is highly recommended.Those patients with identified risk factors deserve special attention.
文摘Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.
基金Liaoning Province Applied Basic Research Program Joint Program Project,No.2022JH2/101500076Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program,No.RC200438+1 种基金Tree Planting Program of Shengjing Hospital,No.M1595the Doctoral Start-up Foundation of Liaoning Province,No.2022-BS-127.
文摘Clear cell sarcoma(CCS)is a rare melanocytic soft tissue sarcoma known for itspropensity to metastasize to the lymph nodes and typically has an unfavorableprognosis.Currently,surgical resection is the primary treatment for localizedCCS,while radiotherapy and chemotherapy are preferred for metastatic cases.The roles of adjuvant chemotherapy,radiotherapy,and lymph node dissection arecontroversial.Although immunotherapy has emerged as a promising avenue inCCS treatment research,there are no established clinical standards for postoperativefollow-up.This editorial discusses a recent article by Liu et al,with afocus on current diagnostic modalities,treatment approaches,and the challengingprognosis associated with CCS.Our aim is to underscore the importance of longtermpatient follow-up in CCS management.
文摘BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.
文摘Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest from scientists and practitioners, though it is recognized as one of the weakest points of EIA systems globally. Also, EIA follow-up is influenced by the context, mainly in terms of the types of projects or activities and their related impacts on the environment. Therefore, the present paper is focused on the investigation of the follow-up stage applied to the activity of seismic survey coupled with offshore oil & gas exploitation in Brazil. Research was based on a qualitative approach that included document analysis and semi-structured interviews with analysts involved in EIA processes, and sought to generate evidence of effectiveness of the EIA follow-up as conducted by the Federal Environment Agency (Ibama) in order to situate the practice of follow-up in the broader context of international best practice principles. Based on the findings, it was concluded that, due to the peculiarities of offshore seismic survey, it is necessary to promote adaptations in the procedures for monitoring impacts in order to ensure proper alignment with the principles and conceptual foundations that guide EIA practice. Specifically, the timing of the execution of the activity imposes challenges for its integration into the “conventional” cycle that has guided the monitoring of the impacts in the EIA of projects.
文摘BACKGROUND Several studies found that early pancreatic atrophy detected by computed tomo-graphy(CT)within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis(AIP)receiving steroid therapy;however,no long-term follow-up studies have been performed.AIM To investigate pancreatic volume(PV)changes using three dimensional(3D)-CT volumetry and their relationship with IgG4 and diabetes in patients with AIP.METHODS This retrospective study included 33 patients with type-1 AIP receiving steroid therapy.Patients were divided into diffuse(D-type)and mass-forming type(M-type)AIP.PV was determined by semi-automated 3D-CT volumetry,and changes between initial and follow-up values were calculated.The relationship between PV and serum IgG4 levels was analyzed by Spearman’s rank correlation.The PV atrophy ratio compared with the presumed normal PV at the time of last follow-up CT and its relationship with diabetes were investigated.RESULTS There were 16 D-type and 17 M-type patients with long-term follow-up(mean,95.8 months).The regression curve of mean relative PV change reduced exponentially and rapidly during the first 25 months and then more slowly in both groups.The overall cumulative pancreas re-enlargement rates at 1,3,5,7 and 10 years were 6.1%,12.2%,29.2%,47.5%and 55.0%,respectively.There was a moderate-to-very strong positive correlation(ρ≥0.4)between PV and serum IgG4 levels in nine(9/13,69.2%)patients.All 33 patients showed pancreatic atrophy(mean 59.3%)after long-term follow-up.Patients with D-type AIP had a significantly higher atrophy rate and higher incidence of diabetes than M-type patients(P<0.05).CONCLUSION PV change initially reduced exponentially and then more slowly and is considered an important factor associated with diabetes.Serum IgG4 levels were positively correlated with PV during follow-up.
文摘In the digital age,traditional media ethics norms lack sufficient explanatory power and binding force in practice.This paper uses the“Primary School Student Lost Homework in Paris”incident as a case study to explore the ethical controversies surrounding the dissemination of this event.By adopting a hierarchical media ethics perspective,the paper dynamically examines the ethical conduct of various communicators,elucidates the ethical responsibilities of each party involved,and reveals the complexity of communication ethics in the digital age.
基金Project(2007CB613704)supported by the National Basic Research Program of China
文摘The microstructure and mechanical properties of Mg-10.1Gd-3.74Y-0.25Zr (mass fraction, %) alloy (GW104 alloy) cast by metal mould casting (MMC) and lost foam casting (LFC) were evaluated, respectively. It is revealed that different forming modes do not influence the phase composition of as-cast alloy. In the as-cast specimens, the microstructures are similar and composed of α-Mg solid solution, eutectic compound of α-Mg+Mg 24 (Gd, Y) 5 and cuboid-shaped Mg 5 (Gd, Y) phase; whereas the average grain size of the alloy produced by metal mould casting is smaller than that by lost foam casting. The eutectic compound of the alloy is completely dissolved after solution treatment at 525 ℃for 6 h, while the Mg 5 (Gd, Y) phase still exists after solution treatment. After peak-ageing, the lost foam cast alloy exhibits the maximum ultimate tensile strength of 285 MPa, and metal mould cast specimen 325 MPa at room temperature, while the tensile yield strengths of them are comparable. It can be concluded that GW104 alloy cast by lost foam casting possesses similar microstructure and evidently lower mechanical strength compared with metal mould cast alloy, due to slow solidification rate and proneness to form shrinkage porosities during lost foam casting process.
基金Supported by 2021 Disciplinary Construction Project in School of Dentistry,Anhui Medical University,No.2021kqxkFY05.
文摘BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.
文摘The Lost Generation is actually a group of American writers who were rebelling against what America had become by the 1900s.The Lost generation tendency and Lost generation writers are of great importance to the American and world literature.This article serves as a brief introduction to the Lost generation and its significant writers.
文摘《The Lost Garden》是美国著名华裔儿童文学作家叶祥添的自传,已被选录入美国中学世界文学教科书,从文体学的角度入手,对《The Lost Garden》的语言特征进行研析,能更深入地挖掘美籍华裔作家叶祥添的语言风格、语用意图和创作主旨。运用文体学方法,从词汇、句子、语篇及修辞等四个不同的层面,对《The Lost Garden》的文体特征进行细致分析,通过探讨该文本语言在这四个不同层面的特征,作品的语言特色得以凸现,读者得以更走近文本,这有助于读者更深刻地理解该文本的文体风格,更准确地分析作品的人物特征及把握作者的意图,从而更加全面、正确地理解和鉴赏作品。
文摘Porosity is thought to be severe in aluminum alloy castings produced by lost foam process due to the pyrolysis of the polystyrene foam pattern during pouring, which results in detrimental effect in mechanical property. The slow solidification rate promotes the formation of gassing pin holes, and relative weakness of the thermal gradients can cause micro-shrinkage if the outline of the part complicates feeding in the lost foam casting. One of the methods to eliminate the porosity is to apply high pressure to the molten metal like an isostatic forging during solidification. Fundamental experiments were carried out to evaluate the effect of the external pressure on the porosity and mechanical properties of A356.2 alloy bar in the lost foam casting. Solidification time and porosity decreased with increasing the applied pressure during solidification. Applying external pressure was effective in decreasing the porosity and increasing the elongation of the lost foam casting.
文摘The importance of follow-up education of college English has been obvious in recent years, but there are still many problems which need to be solved as soon as possible, such as how to carry out the follow-up education effectively and in what way to conduct the follow-up education and the course arrangement. The thesis hopes to solve the above problems to some extent.