<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal ca...<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following </span><span style="font-family:Verdana;">poor obstetric outcomes: premature rupture of the membranes, post-maturity, </span><span style="font-family:Verdana;">low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.</span></span>展开更多
BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communic...BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery.Identification of the risk factors for complications and readmissions after TKA,taking into account common causes,temporal trends,and risk variables that can be changed or left unmodified,will benefit this process.AIM To assess readmission rates,early complications and their causes after TKA at 30 days and 90 days post-surgery.METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1,2017,and February 28,2022.Of the 633 patients,28 were not contactable,leaving 609 who met the inclusion criteria.Both inpatient and outpatient hospital records were retrieved,and observations were noted in the data collection forms.RESULTS Following TKA,the 30-day and 90-day readmission rates were determined to be 1.1%(n=7)and 1.8%(n=11),respectively.The unplanned visit rate at 30 days following TKA was 2.6%(n=16)and at 90 days was 4.6%(n=28).At 90 days,the unplanned readmission rate was 1.4%(n=9).Reasons for readmissions included medical(27.2%,n=3)and surgical(72.7%,n=8).Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group(P=0.922),body mass index(BMI)(P=0.633),unilateral vs bilateral TKA(P=0.696),or patient comorbidity status(30-day P=0.171 and 90-day P=0.813).Reoperation rates after TKA were 0.66%(n=4)at 30 days and 1.15%(n=8)at 90 days.The average length of stay was 6.53 days.CONCLUSION In this study,there was a low readmission rate following TKA.There was no significant correlation between readmission rate and patient factors such as age,BMI,and co-morbidity status.展开更多
According to the Environmental Protection Agency (EPA), fish consumption is the most significant route of mercury exposure, and the concern is greatest for women of childbearing age due to the potential for neurodevel...According to the Environmental Protection Agency (EPA), fish consumption is the most significant route of mercury exposure, and the concern is greatest for women of childbearing age due to the potential for neurodevelopmental effects on a developing fetus. Rates of developmental disorders vary. But in 2008 it was demonstrated that the rate of autism is higher near industries that emit heavy metals. Furthermore past research findings can be taken to show that where a pregnancy occurred may predict later autism likelihood in the offspring more than where diagnosis occurs. If mercury plays any role in developmental disabilities, the rate of disability should relate to any reliable direct measure of contamination. The current research focuses on one index of environmental mercury contamination. Specifically, mercury-related fish advisories are found to be a surprisingly strong predictor of a state’s autism rate, r = 0.48, p < 0.001. The relationship remains strong after controlling for student to teacher ratio and per pupil spending. It is argued that a secular increase in autism has been occurring and that prenatal exposure to heavy metal toxins may play a significant role. Because we suspect this finding may be of some interest, the full data set is provided in the appendix so that researchers can independently analyze the key findings which rely on CDC, EPA and IDEA data sets.展开更多
Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast c...Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.展开更多
Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up...Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In th...BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.展开更多
Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year ...Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. Results: Forty women (56%) completed the 10-year follow-up. Eighteen women (25%) had died within the ten-year follow-up period and fourteen women (19%) were lost to follow-up. Six (15%) of the women who came for follow-up had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period and were analysed as a separate group. Of the 40 women who came for the 10-year clinical examination none had stage 0 pelvic organ prolapse. Twenty (50%) women had stage 1, whereas, 13 (32%) had stage 2 and 1 (3%) had stage 3 pelvic organ prolapse. Ten years after surgery, 28 women (70%) had no bulge symptoms. Six (15%) of the women experienced bulge symptoms at the time of follow-up. Ten years postoperatively, 30 (75%) of the women in an overall quality of life assessment considered their condition improved after surgery. Conclusion: At 10-year follow-up 70% of women were relieved from their bulge symptoms and 75% still considered themselves better or much better than before the operation. However, 15% of women had been reoperated and 15% still experienced bulge symptoms.展开更多
文摘<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following </span><span style="font-family:Verdana;">poor obstetric outcomes: premature rupture of the membranes, post-maturity, </span><span style="font-family:Verdana;">low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.</span></span>
文摘BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery.Identification of the risk factors for complications and readmissions after TKA,taking into account common causes,temporal trends,and risk variables that can be changed or left unmodified,will benefit this process.AIM To assess readmission rates,early complications and their causes after TKA at 30 days and 90 days post-surgery.METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1,2017,and February 28,2022.Of the 633 patients,28 were not contactable,leaving 609 who met the inclusion criteria.Both inpatient and outpatient hospital records were retrieved,and observations were noted in the data collection forms.RESULTS Following TKA,the 30-day and 90-day readmission rates were determined to be 1.1%(n=7)and 1.8%(n=11),respectively.The unplanned visit rate at 30 days following TKA was 2.6%(n=16)and at 90 days was 4.6%(n=28).At 90 days,the unplanned readmission rate was 1.4%(n=9).Reasons for readmissions included medical(27.2%,n=3)and surgical(72.7%,n=8).Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group(P=0.922),body mass index(BMI)(P=0.633),unilateral vs bilateral TKA(P=0.696),or patient comorbidity status(30-day P=0.171 and 90-day P=0.813).Reoperation rates after TKA were 0.66%(n=4)at 30 days and 1.15%(n=8)at 90 days.The average length of stay was 6.53 days.CONCLUSION In this study,there was a low readmission rate following TKA.There was no significant correlation between readmission rate and patient factors such as age,BMI,and co-morbidity status.
文摘According to the Environmental Protection Agency (EPA), fish consumption is the most significant route of mercury exposure, and the concern is greatest for women of childbearing age due to the potential for neurodevelopmental effects on a developing fetus. Rates of developmental disorders vary. But in 2008 it was demonstrated that the rate of autism is higher near industries that emit heavy metals. Furthermore past research findings can be taken to show that where a pregnancy occurred may predict later autism likelihood in the offspring more than where diagnosis occurs. If mercury plays any role in developmental disabilities, the rate of disability should relate to any reliable direct measure of contamination. The current research focuses on one index of environmental mercury contamination. Specifically, mercury-related fish advisories are found to be a surprisingly strong predictor of a state’s autism rate, r = 0.48, p < 0.001. The relationship remains strong after controlling for student to teacher ratio and per pupil spending. It is argued that a secular increase in autism has been occurring and that prenatal exposure to heavy metal toxins may play a significant role. Because we suspect this finding may be of some interest, the full data set is provided in the appendix so that researchers can independently analyze the key findings which rely on CDC, EPA and IDEA data sets.
文摘Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.
基金supported by grants from the National Natural Science Foundation of China,grant no. 81370041, 81771233, 81671655the Outstanding Clinical Discipline Project of Shanghai Pudonggrant no.PWYgy2018-04.
文摘Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.
基金Compliance with local ethical and data protection policies.Registered with St Georges University Hospitals NHS Foundation Trust Quality Assurance Department.Registration no AUD1000854。
文摘BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.
文摘Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. Results: Forty women (56%) completed the 10-year follow-up. Eighteen women (25%) had died within the ten-year follow-up period and fourteen women (19%) were lost to follow-up. Six (15%) of the women who came for follow-up had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period and were analysed as a separate group. Of the 40 women who came for the 10-year clinical examination none had stage 0 pelvic organ prolapse. Twenty (50%) women had stage 1, whereas, 13 (32%) had stage 2 and 1 (3%) had stage 3 pelvic organ prolapse. Ten years after surgery, 28 women (70%) had no bulge symptoms. Six (15%) of the women experienced bulge symptoms at the time of follow-up. Ten years postoperatively, 30 (75%) of the women in an overall quality of life assessment considered their condition improved after surgery. Conclusion: At 10-year follow-up 70% of women were relieved from their bulge symptoms and 75% still considered themselves better or much better than before the operation. However, 15% of women had been reoperated and 15% still experienced bulge symptoms.
