Sampsonthompson8527
Conclusions Factors related to HRQOL 2 years after LVAD implantation include demographic, clinical, and psychological variables.
One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months.
Prognostic factors Any factors measured within one month after stroke with the aim of predicting independent walking. Outcome of interest Independent walking defined as walking with or without an aid but with no human assistance.
Fifteen studies comprising 2344 nonambulatory participants after stroke were included. Risk of bias was low in 7 studies and moderate in 8 studies. Individual meta-analyses of 2 to 4 studies were performed to calculate the pooled estimate of the odds ratio for 12 prognostic factors. Younger age (odds ratio [OR], 3.4,
<0.001), an intact corticospinal tract (OR, 8.3,
<0.001), good leg strength (OR, 5.0,
<0.001), no cognitive impairment (OR, 3.5,
<0.001), no neg3 months. Registration URL https//www.crd.york.ac.uk/prospero/; Unique identifier CRD42018108794.
Outcome prediction after aneurysmal subarachnoid hemorrhage (aSAH) is challenging. CRP (C-reactive protein) has been reported to be associated with outcome, but it is unclear if this is independent of other predictors and applies to aSAH of all grades. Therefore, the role of CRP in aSAH outcome prediction models is unknown. The purpose of this study is to assess if CRP is an independent predictor of outcome after aSAH, develop new prognostic models incorporating CRP, and test whether these can be improved by application of machine learning.
This was an individual patient-level analysis of data from patients within 72 hours of aSAH from 2 prior studies. A panel of statistical learning methods including logistic regression, random forest, and support vector machines were used to assess the relationship between CRP and modified Rankin Scale. Models were compared with the full Subarachnoid Hemmorhage International Trialists' (SAHIT) prediction tool of outcome after aSAH and internally validated using cross-vapendent predictor of outcome after aSAH. Its inclusion in prognostic models improves performance, although the magnitude of improvement is probably insufficient to be relevant clinically on an individual patient level, and of more relevance in research. Greater improvements in model performance are seen with support vector machines but these models have the highest classification error rate on internal validation and require external validation and calibration.Background We aimed to provide personalized risk estimates for cardiac events (CEs) and life-threatening events in women with either type 1 or type 2 long QT. Methods and Results The prognostic model was derived from the Rochester Long QT Syndrome Registry, comprising 767 women with type 1 long QT (n=404) and type 2 long QT (n=363) from age 15 through 60 years. The risk prediction model included the following variables genotype/mutation location, QTc-specific thresholds, history of syncope, and β-blocker therapy. A model was developed with the end point of CEs (syncope, aborted cardiac arrest, or long QT syndrome-related sudden cardiac death), and was applied with the end point of life-threatening events (aborted cardiac arrest, sudden cardiac death, or appropriate defibrillator shocks). External validation was performed with data from the Mayo Clinic Genetic Heart Rhythm Clinic (N=467; type 1 long QT [n=286] and type 2 long QT [n=181]). The cumulative follow-up duration among the 767 enrolled women was 22 243 patient-years, during which 323 patients (42%) experienced ≥1 CE. Based on genotype-phenotype data, we identified 3 risk groups with 10-year projected rates of CEs ranging from 15%, 29%, to 51%. The corresponding 10-year projected rates of life-threatening events were 2%, 5%, and 14%. C statistics for the prediction model for the 2 respective end points were 0.68 (95% CI 0.65-0.71) and 0.71 (95% CI 0.66-0.76). Corresponding C statistics for the model in the external validation Mayo Clinic cohort were 0.65 (95% CI 0.60-0.70) and 0.77 (95% CI 0.70-0.84). Conclusions This is the first risk prediction model that provides absolute risk estimates for CEs and life-threatening events in women with type 1 or type 2 long QT based on personalized genotype-phenotype data. The projected risk estimates can be used to guide female-specific management in long QT syndrome.
Little is known about the risk of subsequent cardiovascular events in individuals whose spouse has a history of cardiovascular diseases. We assessed whether the spouse's history of cardiovascular disease is associated with a greater risk of cardiovascular events.
Using data on married couples from the Japan Medical Data Center database (April 2008-August 2018), we conducted a matched-pair cohort study by matching individuals who had no history of cardiovascular disease and whose spouse had a history of cardiovascular disease at their first health check-up (exposure group) with up to 4 individuals who had no history of cardiovascular disease and whose spouse had no history of cardiovascular disease at their first health check-up (nonexposure group) matched for birth year, sex, and first health check-up year. FDI-6 order We compared severe cardiovascular events after the first health check-up between the 2 groups.
Among 236 527 eligible married couples (473 054 spouses), we identified 13 759 individuals in the exposut cardiovascular events in men but not in women. Further studies are needed to confirm our findings and to explore effective primary prevention strategies for these individuals.Background Data from the International Registry of Acute Aortic Dissection indicate that the guideline criterion of 5.5 cm for ascending aortic intervention misses many dissections occurring at smaller dimensions. Furthermore, studies of natural behavior have generally treated the aortic root and the ascending aorta as 1 unit despite embryological, anatomical, and functional differences. This study aims to disentangle the natural histories of the aforementioned aortic segments, allowing natural behavior to define specific intervention criteria for root and ascending segments of the aorta. Methods and Results Diameters of the aortic root and mid-ascending segment were measured separately. Long-term complications (dissection, rupture, and death) were analyzed retrospectively for 1162 patients with ascending thoracic aortic aneurysm. Cox regression analysis suggested that aortic root dilatation (P=0.017) is more significant in predicting adverse events than mid-ascending aortic dilatation (P=0.087). Short stature posed as a serious risk factor. The dedicated risk curves for the aortic root and the mid-ascending aorta revealed hinge points at 5.0 and 5.25 cm, respectively. Conclusions The natural histories of the aortic root and mid-ascending aorta are uniquely different. Dilation of the aortic root imparts a significant higher risk of adverse events. A diameter shift for intervention to 5.0 cm for the aortic root and to 5.25 cm for the mid-ascending aorta should be considered at expert centers.While published guidelines are useful in the care of patients with long-QT syndrome, it can be difficult to decide how to apply the guidelines to individual patients, particularly those with intermediate risk. We explored the diversity of opinion among 24 clinicians with expertise in long-QT syndrome. Experts from various regions and institutions were presented with 4 challenging clinical scenarios and asked to provide commentary emphasizing why they would make their treatment recommendations. All 24 authors were asked to vote on case-specific questions so as to demonstrate the degree of consensus or divergence of opinion. Of 24 authors, 23 voted and 1 abstained. Details of voting results with commentary are presented. There was consensus on several key points, particularly on the importance of the diagnostic evaluation and of β-blocker use. There was diversity of opinion about the appropriate use of other therapeutic measures in intermediate-risk individuals. Significant gaps in knowledge were identified.AirwayCentric approach to prevention of dentofacial disorders. The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.
Localised juvenile spongiotic gingival hyperplasia (LJSGH) is a benign lesion occurring in young patients as gingival erythema and overgrowth, typically localised on gingiva of maxillary incisors. The aim of this work is to report a case of LJSGH where complete spontaneous regression was achieved together with a review of the literature on the topic.
An 8-year-old girl was referred for a gingival painless lesion, which had appeared spontaneously one year before and was refractory to periodontal treatment. Intraoral examination showed a well-defined, red gingival overgrowth involving the left maxillary central incisor, without involving the marginal gingiva. The clinical diagnosis of LJSGH was made, due to the pathognomonic aspect. The patient was periodically recalled for 43 months; at the last visit, the lesion was spontaneously resolved.
LJSGH is not plaque-related and not responsive to periodontal treatment. Surgical removal of the lesions correlates with high recurrence, while spontaneous resolution over time has been hardly demonstrated.
Follow-up of LJSGH may be an option of care, alternative to surgery, in selected cases.
Follow-up of LJSGH may be an option of care, alternative to surgery, in selected cases.
Eating disorders (ED) are a group of psychopathological disorders that affect the patient's relationship with food and his own body and that are manifested mainly in adolescence and in young-adult age. ED include anorexia nervosa (AN), bulimia nervosa (BN) and other eating disorders as classified in the DMS-V. ED can result in several oral and dental manifestations that often occur in the early stages of ED and may allow early detection. The aim of the study is to describe the different oral and dental manifestations in patients with ED in order to offer a classification for their identification during an extra/intra-oral examination.
A search on PubMed, Medline and Cochrane Library data bases has been performed.
Oral manifestations in ED patients include a variety of signs and symptoms, which involve the oral mucosa and perioral tissues (exfoliative cheilitis, labial erythema, atrophic glossitis, glossodynia, yellow-orange colouration of the soft palate, cheek/lip biting, candidiasis), the teeth (dental erosion, tooth hypersensitivity, dental caries), periodontal diseases, and salivary manifestations (sialoadenosis, alterations in salivary flow).
