Ryeputnam1876

BACKGROUND The benefits of using energy devices (EDs) such as ultrasonic coagulating shears or electrothermal bipolar vessel sealing devices for thyroid cancer surgery have been evaluated only with limited data obtained from small samples. MATERIALS AND METHODS Using a Japanese national inpatient database, we identified 59,394 patients with thyroid cancer who underwent thyroidectomy without EDs (without-ED group, n = 32,360) and with EDs (with-ED group, n = 26,764) from July 2010 to March 2017. One-to-one propensity score matching was performed to compare the occurrence of postoperative complications including recurrent laryngeal nerve paralysis and chyle leakage, duration of anesthesia, length of stay, total costs, in-hospital mortality rate between the two groups. We also performed multivariate regression analyses using a generalized estimating equation and multiple imputation as a sensitivity analysis. RESULTS In the propensity-matched analysis involving 22,108 pairs, no significant differences were found in any postoperative complications (7.4% vs. 7.3%, p = 0.73), duration of anesthesia (217 min vs. 218 min, p = 0.54), length of stay (8.7 days vs. 8.2 days, p = 0.07) and in-hospital mortality rate (0.07% vs. 0.09%, p = 0.61). Compared with the without-ED group, the with-ED group showed a lower occurrence of postoperative recurrent laryngeal nerve paralysis (2.3% vs. 2.7%, p = 0.01) but a higher occurrence of postoperative chyle leakage (0.3% vs. 0.1%, p  less then  0.001) and total cost (US $7246 vs. US $6937, p  less then  0.001). The multivariate regression analysis showed compatible results with the propensity-matched analysis. CONCLUSION In this large nationwide cohort of patients with thyroid cancer, no significant difference was detected in the proportions of any complications. The use of EDs was associated with a lower occurrence of postoperative recurrent laryngeal nerve paralysis but a higher occurrence of postoperative chylothorax and higher cost. BACKGROUND The clinical trial of tiotropium in chronic obstructive pulmonary disease (COPD), i.e. UPLIFT, enrolled adults with a mean age of 65 years and moderate-to-severe airflow-obstruction, based on criteria from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For the UPLIFT cohort, however, GOLD-based criteria are not age-appropriate. RESEARCH QUESTION Will the use of more age-appropriate criteria for airflow-obstruction from the Global Lung Function Initiative (GLI) modify the spirometric classification of the UPLIFT cohort and, in turn, the mortality effect of tiotropium in COPD? STUDY DESIGN and Methods Baseline spirometric classifications were first cross-tabulated by GLI- and GOLD-based criteria. Next, in GLI- and GOLD-based airflow-obstruction, modified intention-to-treat analyses evaluated differences in time-to-death over 4 years, comparing tiotropium vs. placebo. Since treatment response may differ by COPD severity, the mortality effect was also evaluated within stratum defineassification by the original GOLD-based enrollment criteria. BACKGROUND Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is recommended for people at high risk of dying from lung cancer. Communication strategies for clinicians have been recommended but their influence on patient-centered outcomes is unclear. We aimed to determine how patients experience communication and decision-making with clinicians when offered lung cancer screening (LCS). METHODS We performed semi-structured interviews with 51 patients from three institutions with established LCS programs. We focused on communication domains such as information exchange, patient as person, and shared decision-making (SDM). Using conventional content analysis, we report on patients' assessment of information, reasons for (dis)satisfaction, distress, and role in the decision-making process. RESULTS Participants recalled few specific harms or benefits of screening, but uniformly reported satisfaction with the amount of information provided. All participants reported that clinicians did not explicitly ask about their values and preferences and about half reported some distress in anticipation of screening results. Almost all participants were satisfied with their role in the decision-making process. Despite participants' reporting that they did not experience all aspect of SDM as defined, they reported high levels of trust in clinicians which may relate to their largely positive reactions to the LCS decision interaction through the patient as person domain of communication. CONCLUSIONS Although decision-making for lung cancer screening as currently practiced may not meet all criteria of high-quality communication, patients in our sample are satisfied with the process, and report high trust in clinicians. Patients may place greater importance on interpersonal aspects of communication rather than information exchange. BACKGROUND One of the key mechanisms underlying obstructive sleep apnea (OSA) is a reduced pharyngeal muscle tone during sleep. Recent data suggest that pharmacological augmentation of central serotonergic/adrenergic tone increases pharyngeal muscle tone. RESEARCH QUESTION We hypothesized that venlafaxine, a serotonin-norepinephrine reuptake inhibitor, would improve OSA severity. STUDY DESIGN and Methods In this mechanistic, randomized, double-blind, placebo-controlled crossover trial, 20 OSA patients underwent two overnight polysomnograms >4days apart receiving either 50mg immediate-release venlafaxine or placebo before bedtime. Primary outcomes were the apnea hypopnea index (AHI) and SpO2 nadir; secondary outcomes included sleep parameters and pathophysiological traits with a view towards understanding its impact on mechanisms underlying OSA. RESULTS Overall there was no significant difference between venlafaxine vs placebo with regards to AHI (mean reduction -5.6 events/h [95%-CI -12.0 to 0.9], P=.09) or SpO2 nadir (median increase +1.0% [-0.5 to 5], P=.11). STI571 chemical structure Venlafaxine reduced total sleep time, sleep efficiency and rapid eye movement (REM) sleep, while increasing Non-REM stage 1 sleep (Pall0.5, P less then .02). INTERPRETATION In unselected patients, venlafaxine simultaneously worsened and improved different pathophysiological traits resulting in a zero net-effect. Careful patient selection based on pathophysiological traits or combination-therapy with drugs countering its alerting effects may produce a more robust response.