• Title/Summary/Keyword: Long-term prognosis

검색결과 361건 처리시간 0.023초

Clinical Prognostic Score for Predicting Disease Remission with Differentiated Thyroid Cancers

  • Somboonporn, Charoonsak;Mangklabruks, Ampica;Thakkinstian, Ammarin;Vatanasapt, Patravoot;Nakaphun, Suwannee
    • Asian Pacific Journal of Cancer Prevention
    • /
    • 제17권6호
    • /
    • pp.2805-2810
    • /
    • 2016
  • Background: Differentiated thyroid cancer is the most common endocrine malignancy with a generally good prognosis. Knowing long-term outcomes of each patient helps management planning. The study was conducted to develop and validate a clinical prognostic score for predicting disease remission in patients with differentiated thyroid cancer based on patient, tumor and treatment factors. Materials and Methods: A retrospective cohort study of 1,217 differentiated thyroid cancer patients from two tertiary-care hospitals in the Northeast of Thailand was performed. Associations between potential clinical prognostic factors and remission were tested by Cox proportional-hazards analysis in 852 patients (development cohort). The prediction score was created by summation of score points weighted from regression coefficients of independent prognostic factors. Risks of disease remission were estimated and the derived score was then validated in the remaining 365 patients (validation cohort). Results: During the median follow-up time of 58 months, 648 (76.1%) patients in the development cohort had disease remission. Five independent prognostic factors were identified with corresponding score points: duration from thyroid surgery to $^{131}I$ treatment (0.721), distant metastasis at initial diagnosis (0.801), postoperative serum thyroglobulin level (0.535), anti-thyroglobulin antibodies positivity (0.546), and adequacy of serum TSH suppression (0.293). The total risk score for each patient was calculated and three categories of remission probability were proposed: ${\leq}1.628$ points (low risk, 83% remission), 1.629-1.816 points (intermediate risk, 87% remission), and ${\geq}1.817$ points (high risk, 93% remission). The concordance (C-index) was 0.761 (95% CI 0.754-0.767). Conclusions: The clinical prognostic scoring model developed to quantify the probability of disease remission can serve as a useful tool in personalized decision making regarding treatment in differentiated thyroid cancer patients.

Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

  • Choi, Hyun-Jung;Kim, Min Chul;Sim, Doo Sun;Hong, Young Joon;Kim, Ju Han;Jeong, Myung Ho;Kim, Soo-Hyun;Shin, Myung-Geun;Ahn, Youngkeun
    • Annals of Laboratory Medicine
    • /
    • 제38권6호
    • /
    • pp.538-544
    • /
    • 2018
  • Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P =0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

전치부 과개교합을 가진 상하악 부분 무치악 환자에서의 상악 하이브리드 텔레스코픽 이중관 국소의치와 하악 고정성 보철물을 이용한 치료의 11년 경과관찰 증례 (Prosthetic treatment for patient with anterior overbite and partial edentulism using maxillary hybrid telescopic double crown RPD and mandibular fixed prostheses: A 11-yr follow-up)

  • 최현석;조진현
    • 대한치과보철학회지
    • /
    • 제59권4호
    • /
    • pp.415-421
    • /
    • 2021
  • 소수 잔존치가 남아있거나 치주적으로 불리한 경우 전통적인 가철성 국소의치의 생역학적 예후가 불분명하다. 이러한 경우, 하이브리드 텔레스코픽 이중관 국소의치(hybrid telescopic double crown RPD)는 성공적인 치료의 대안이 될 수 있다. 이 치료방법의 경우 지대치 간의 이차고정 효과가 있으며 응력의 방향이 수직적이고, 지대치 발치 시에 의치의 수리가 용이하다는 점에서 전통적인 가철성 국소의치에 비해 장점을 보인다. 본 증례에서는 전치부의 과개교합을 가진 상하악의 부분 무치악 환자에 있어 상악에는 이중관 의치, 하악에는 임플란트 및 고정성 보철치료가 시행되었다. 장기간 동안 경과관찰 및 유지관리 치료를 시행한 결과, 기능 및 심미적인 면에서 만족할 만한 성과를 얻었기에 이를 보고하고자 한다.

Prognostic Impact of Extended Lymph Node Dissection versus Limited Lymph Node Dissection on pN0 Proximal Advanced Gastric Cancer: a Propensity Score Matching Analysis

  • Park, Sung Hyun;Son, Taeil;Seo, Won Jun;Lee, Joong Ho;Choi, Youn Young;Kim, Hyoung-Il;Cheong, Jae-Ho;Noh, Sung Hoon;Hyung, Woo Jin
    • Journal of Gastric Cancer
    • /
    • 제19권2호
    • /
    • pp.212-224
    • /
    • 2019
  • Purpose: Splenic hilar lymph node dissection (LND) during total gastrectomy is regarded as the standard treatment for proximal advanced gastric cancer (AGC). This study aimed to investigate whether splenic hilar LND or D2 LND is essential for proximal AGC of pT2- 4aN0M0 stage. Materials and Methods: Data of curative total gastrectomies (n=370) performed from 2000 to 2010 for proximal AGC of pT2-4aN0 stage were retrospectively reviewed. Clinicopathological characteristics and long-term outcomes were compared using propensity score matching between patients who underwent splenectomy (n=43) and those who did not (n=327) and between patients who underwent D2 LND (n=122) and those who underwent D1+ LND (n=248). Results: Tumors of larger size and a more advanced T stage and significantly lower overall and relapse-free survival (P<0.001) were observed in the splenectomy group than in the 2 spleen-preserving groups. Before propensity score matching, worse overall and relapse-free survival (P<0.001) was observed in the splenectomy group than in the non-splenectomy group. After matching, although the overall survival became similar (P=0.123), relapse-free survival was worse in the splenectomy group (P=0.021). Compared with D1+ LND, D2 LND had no positive impact on the overall (P=0.619) and relapse-free survival (P=0.112) after propensity score matching. Conclusions: Splenic hilar LND with or without splenectomy may not have an oncological benefit for patients with pathological AGC with no LN metastasis.

CONCEPT AND MANAGEMENT OF ISTISQĀ' (OEDEMA) IN UNANI SYSTEM OF MEDICINE

  • Khan, Khalid Ali;Zakir, Mohammad;Khan, Shahid Ali;Khan, Rashid Ali
    • 셀메드
    • /
    • 제11권1호
    • /
    • pp.3.1-3.6
    • /
    • 2021
  • Ascites is the accumulation of fluid in the peritoneal cavity, and it is generally allied with liver disease like cirrhosis of the liver. The ascites is commonly associated with liver cirrhosis, malignancy, or cardiovascular disease today. The liver cirrhosis is the most significant cause of ascites in developed countries as per the available data. In the modern medicine system, the treatment includes the restriction of sodium intake, use of diuretics, and paracentesis done in severe cases. There are many side effects of synthetic chemical diuretics, and their long-term use is not recommended. The alternative medicine like Unani system of medicine provides natural diuretics and drugs which also have protective effects on kidney, liver and other internal organs. It is well known in all drug systems that the prognosis is poor in ascites, but the use of Unani herbal medicines can minimize the side effects caused by synthetic chemical diuretics. The natural herbs used for the management of ascites have fewer side effects as compared to synthetic drugs. The natural drugs can be used for longer duration and provide some dietary supplement which improves the quality of life. This review addressed the thorough treatment of ascites by natural diet and medications.

서지컬 가이드를 이용한 하악 임플란트 피개의치 수복 증례 (Oral rehabilitation of edentulous patient with mandibular implant overdenture using surgical guide)

  • 이동환;류재준
    • 대한치과보철학회지
    • /
    • 제60권4호
    • /
    • pp.339-346
    • /
    • 2022
  • 전통적인 총의치와 비교했을 때 하악 임플란트 피개의치는 2개의 임플란트로도 좋은 지지와 유지를 얻을 수 있다는 장점이 있다. 2개의 임플란트를 이용하여 하악 임플란트 피개의치를 제작할 때는 정확한 위치에 임플란트를 식립하는 것이 중요하다. 2개의 임플란트를 교합평면에 수직 방향으로, 견치 자리에 서로 평행하게 식립해야 피개의치의 장기적인 예후에 좋다. 하지만 무치악 환자에서 2개의 임플란트를 올바른 위치에 식립하는 것은 어려운 일이며, 이 때 서지컬 가이드를 이용한다면 보철적으로 유리한 위치에 임플란트를 식립하는데 도움을 받을 수 있다. 본 증례는 57세 남환으로 치주질환으로 인해 상, 하악의 모든 치아가 발거된 상태로 본원에 내원했다. 이에 상악은 전통적인 총의치, 하악은 2개의 임플란트를 이용한 임플란트 피개의치로 수복하여 기능 및 심미적으로 만족스러운 결과를 얻었으므로 이를 보고하고자 한다.

The Coordinative Locomotor Training Intervention Strategy Using the ICF Tool to Improve the Standing Posture in Scoliosis: A Case Report

  • Lee, Jeong-a;Kim, Jin-cheol
    • The Journal of Korean Physical Therapy
    • /
    • 제33권1호
    • /
    • pp.7-15
    • /
    • 2021
  • Purpose: This study was examined to improve the standing posture of a scoliosis client using the ICF Tool. Methods: For examination, the study subject was a 16-year-old female student diagnosed with 3curve-pelvic (3CP) type scoliosis. Information about her were collected through a client interview and based on international Classification of Functioning, Disability and Health (ICF). The ICF core set was for post-acute musculoskeletal conditions, and the ICF level 2 items suggested by National Rehabilitation Information Center (NARIC) were added to the recommendations for scoliosis. For evaluation, the ICF assessment sheet was used to identify the interaction among the problems. For the diagnosis, the client's functional problems were described in ICF terms. For the prognosis, the global goals for reaching the client's functional activity and participation level were presented as the long-and short-term goals. For the intervention, a coordinative locomotor training program composed of warm-up, main exercise, and cool-down was applied 3 times a week, 50 minutes a day, for 5 weeks. For the outcome, the differences between before and after the intervention were compared with the ICF qualifier and are shown with the ICF evaluation display. Results: Clinical advantages were observed in body function and structure (7° decrease of thoracic angle, 7 score increase of trunk muscle power, 6.47s improve of one leg standing, 4 score decrease of neck pain). The activity for maintaining the standing posture, in which the client had a primary limitation, was improved. Conclusion: Applying the coordinative locomotor training program is expected to improve scoliosis client's standing posture.

A systematic review of the biological mechanisms linking physical activity and breast cancer

  • Hong, Bok Sil;Lee, Kang Pa
    • 운동영양학회지
    • /
    • 제24권3호
    • /
    • pp.25-31
    • /
    • 2020
  • [Purpose] Epidemiological evidence has shown that leisure-time physical activity and structured exercise before and after breast cancer diagnosis contribute to reducing the risk of breast cancer recurrence and mortality. Thus, in this review, we aimed to summarize the physical activity-dependent regulation of systemic factors to understand the biological and molecular mechanisms involved in the initiation, progression, and survival of breast cancer. [Methods] We systematically reviewed the studies on 1) the relationship between physical activity and the risk of breast cancer, and 2) various systemic factors induced by physical activity and exercise that are potentially linked to breast cancer outcomes. To perform this literature review, PubMed database was searched using the terms "Physical activity OR exercise" and "breast cancer", until August 5th, 2020; then, we reviewed those articles related to biological mechanisms after examining the resulting search list. [Results] There is strong evidence that physical activity reduces the risk of breast cancer, and the protective effect of physical activity on breast cancer has been achieved by long-term regulation of various circulatory factors, such as sex hormones, metabolic hormones, inflammatory factors, adipokines, and myokines. In addition, physical activity substantially alters wholebody homeostasis by affecting numerous other factors, including plasma metabolites, reactive oxygen species, and microRNAs as well as exosomes and gut microbiota profile, and thereby every cell and organ in the whole body might be ultimately affected by the biological perturbation induced by physical activity and exercise. [Conclusion] The understanding of integrative mechanisms will enhance how physical activity can ultimately influence the risk and prognosis of various cancers, including breast cancer. Furthermore, physical activity could be considered an efficacious non-pharmacological therapy, and the promotion of physical activity is probably an effective strategy in primary cancer prevention.

말초성 안면신경마비를 주소로 한방병원에 내원한 소아청소년기 환자 185례에 대한 임상적 특징 분석 (Clinical Characteristics Analysis of 185 Pediatric and Adolescent Patients Who Visited Korean Medicine Hospital with Peripheral Facial Nerve Paralysis)

  • 홍예나;유선애
    • 대한한방소아과학회지
    • /
    • 제37권1호
    • /
    • pp.58-72
    • /
    • 2023
  • Objectives The purpose of this study is to analyze the latest clinical trends in peripheral facial nerve palsy pediatric and adolescent patients who treated in Korean medicine hospital. Methods The study was conducted based on 185 cases of pediatric and adolescent patients with peripheral facial nerve paralysis who visited Korean medicine hospital from January 2017 to June 2022. Results The mean age of onset of facial nerve paralysis in children and adolescents was 11.7 years, and the incidence rate was higher in boys than in girls. The seasonal distribution was the most common in autumn, and 91.4% were diagnosed with Bell's palsy. The recurrence rate was 7.6%. The severity was evaluated on the House-Brackmann Grading System (HBGS) scale, and the most common was Grade III. It took an average of 6.5 days from the date of onset to visit the hospital, and 75.7% visited the hospital within a week from the date of onset. Hospitalized treatment was 69.2%. The higher the HBGS grade, the more hospitalized treatment was, and the total number of treatments and the duration of treatment tended to increase. The average treatment period from the first visit date was 119.6 days. 17.8% received only Korean medicine treatment, and 69.2% took Western medicine with herbal medicine. Conclusions In this study, there was a difference in the average treatment period from previous studies according to the study period setting. Long-term studies on the recovery rate and prognosis of pediatric facial paralysis are needed.

The impact of quality of life measured by WHOQOL-BREF on mortality in maintenance hemodialysis patients: a single center retrospective cross-sectional study

  • Seong Gyu Kim;In Hee Lee
    • Journal of Yeungnam Medical Science
    • /
    • 제40권1호
    • /
    • pp.49-57
    • /
    • 2023
  • Background: Several previous studies have reported that quality of life (QoL) in hemodialysis patients affects mortality. However, the 36-item Short Form Health Survey, which has been used mainly in previous studies, is complicated in terms of questionnaire composition and interpretation. This study aimed to identify the impact of QoL on mortality in hemodialysis patients using an easier and simpler diagnostic tool. Methods: This retrospective study included 160 hemodialysis patients. QoL was evaluated using the World Health Organization Quality of Life Questionnaire-Brief version (WHOQOL-BREF). Psychosocial factors were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Montreal Cognitive Assessment, and Pittsburgh Sleep Quality Index. We also evaluated medical factors, such as dialysis adequacy and laboratory results. Results: The mean hemodialysis vintage was 70.7±38.0 months. The proportion of patients who were elderly was higher in the mortality group than in the surviving group, and the Charlson Comorbidity Index score was also higher in the former group. Of the four domains of the WHOQOL-BREF, the physical health and psychological scores of the mortality group were significantly lower than those of the survival group. When the score in the physical health domain or psychological domain was ≤10, the 10-year mortality rate after hemodialysis initiation increased by approximately 2.3- and 2-fold, respectively. Conclusion: QoL may have a significant effect on mortality in patients undergoing hemodialysis. The WHOQOL-BREF is an instrument that can measure QoL relatively easily and can be used to improve the long-term prognosis of patients undergoing hemodialysis.