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METHODS | We used weighted Cox proportional hazards analysis to assess the independent association between CT findings and hospitalisation or death due to COPD exacerbation . |
RESULTS | During a median follow-up of 4.4 years ( maximum 5.2 years ) , 338 COPD events were identified . |
RESULTS | The risk of experiencing a future acute exacerbation of COPD resulting in hospitalisation or death was significantly increased in subjects with severe emphysema ( score 7 ) and severe airway thickening ( score 3 ) . |
RESULTS | The respective HRs were 4.6 ( 95 % CI 3.0 to 7.1 ) and 5.9 ( 95 % CI 3.4 to 10.5 ) . |
RESULTS | Severe bronchiectasis ( score 3 ) was not significantly associated with increased risk of adverse events ( HR 1.5 ; 95 % CI 0.9 to 2.5 ) . |
CONCLUSIONS | Morphological correlates of COPD such as emphysema and airway thickening detected on CT scans obtained for other non-pulmonary indications are strong independent predictors of subsequent development of acute exacerbations of COPD resulting in hospitalisation or death . |
###24851690 | null |
OBJECTIVE | To explore the feasibility of making a preoperative diagnosis of lung adenocarcinoma shown as ground-glass nodule ( GGN ) on computed tomography ( CT ) . |
METHODS | A total of 143 GGN lesions proved pathologically were divided randomly into A and B groups . |
METHODS | Then each group was further divided pathologically into preinvasive lesion , minimal invasive adenocarcinoma ( MIA ) and invasive adenocarcinoma ( IAC ) subgroups . |
METHODS | Group A ( n = 101 ) , size of lesion , proportion of ground glass opacity ( GGO ) composition of lesion , long diameter , longest diameter and size of solid component in lesion were measured on CT so as to establish the CT diagnostic standard of lung adenocarcinoma shown as GGN on CT. . |
METHODS | Group B ( n = 42 ) was employed to evaluate the accuracy of the above CT diagnostic standard . |
METHODS | SPSS 17.0 software was used for statistical analysis . |
RESULTS | Significant statistic significance existed in all parameters among all groups ( P < 0.05 ) . |
RESULTS | All parameters were correlated the pathologic type of lesion . |
RESULTS | The differences were statistically significant ( P = 0.000 ) . |
RESULTS | Through the receiver operating characteristic ( ROC ) curve , between groups of preinvasive lesion and MIA , each parameter had a medium diagnostic value of 0.70-0 .90 ; between groups of MIA and IAC , size of lesion and long diameter of solid component in lesion had a medium diagnostic value of 0.70-0 .90 , longest diameter of solid component , size of solid component in lesion and proportion of GGO composition of lesion had a high diagnostic value with an AUC of > 0.90 . |
RESULTS | The CT diagnostic standard , derived from group A , was used to analyze the pathologic type of group B. And t no significant statistic significance existed between CT preoperative diagnosis and operative pathologic diagnosis ( P > 0.05 ) . |
RESULTS | The correct diagnosis rates of size of lesion , proportion of GGO composition of lesion , long diameter , longest diameter and size of solid component in lesion were 71.43 % , 76.19 % , 90.05 % , 90.05 % and 88.10 % respectively . |
CONCLUSIONS | Based upon size of lesion , proportion of GGO composition of lesion , long diameter , longest diameter and size of solid component in lesion , preoperative CT examination may be used to determine the pathological types of lung adenocarcinoma shown as GGN . |
###25883103 | null |
OBJECTIVE | Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids . |
OBJECTIVE | Pain control is still a big problem after tonsillectomy surgery . |
OBJECTIVE | We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management . |
OBJECTIVE | This is the first-time use of montelukast in post-tonsillectomy pain . |
METHODS | Double-blind , controlled-randomized study . |
METHODS | University teaching and research hospital . |
METHODS | A total of 60 children , aged 5 to 15 years , American Society of Anesthesiologist class I-II , scheduled for elective tonsillectomy were enrolled in this clinical trial study . |
METHODS | The patients were randomized into 2 groups : the montelukast group ( group M , n = 30 ) and control group ( group C , n = 30 ) . |
METHODS | Group M recieved an oral montelukast tablet and group C recieved placebo at 2400pm on the morning before surgery . |
METHODS | Post-tonsillectomy pain was evaluated with the Wong-Baker FACES Scale during the 24 hours after surgery . |
METHODS | Patients ' intraoperative hemodynamic parameters and intraoperative and postoperative complications were recorded . |
RESULTS | There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores ( P < .05 ) . |
RESULTS | In the 24 hours after surgery , the total number of patients using rescue analgesics was higher in group C than in group M , and the difference was statistically significant ( P < .001 ) . |
RESULTS | There was no significant difference in demographic parameters ( P > .05 ) . |
RESULTS | There were no significant differences in postoperative nausea and vomiting , otalgia , trismus , fever , or halitosis between the groups ( P > .05 ) . |
CONCLUSIONS | Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children . |
###24318863 | null |
OBJECTIVE | Metastatic colon cancer patients are treated with the chemotherapy regimens , FOLFOX and FOLFIRI , in either order . |
OBJECTIVE | So far , we can not predict the response of chemotherapeutic agent , so it is necessary to find which regimen is adequate before starting chemotherapy . |
METHODS | Enrolled patients are randomized into either conventional treatment or planned treatment preceded by pretreatment genetic analysis . |
METHODS | Blood samples of patients in planned treatment group ( N = 53 ) were analyzed for the genetic polymorphism before selection of chemotherapeutic agents . |
METHODS | Target genes were XPD-751 , GSTP-1-105 , XRCC1-399 for oxaliplatin , UGT1A1 for irinotecan . |
METHODS | The response was measured by computed tomographic scan after completion of three cycles of chemotherapy . |
RESULTS | Overall response rate was significantly higher in planned group ( 67.9 % vs. 46.3 % , P = 0.020 ) . |
RESULTS | In FOLFOX group , response rate was significantly improved in the planned patients ( 77.1 % vs. 50 % , P = 0.018 ) . |
RESULTS | In FOLFIRI group , the difference did n't reach statistical significance ( 50 % vs. 42.5 % , P = 0.776 ) . |
CONCLUSIONS | We found significantly improved response rates in the chemotherapy of metastatic colon cancer by pretreatment genetic analysis , especially in FOLFOX group . |
###25872502 | null |
BACKGROUND | Cardiac arrest causes ischaemic brain injury . |
BACKGROUND | Arterial carbon dioxide tension ( PaCO2 ) is a major determinant of cerebral blood flow . |
BACKGROUND | Thus , mild hypercapnia in the 24 h following cardiac arrest may increase cerebral blood flow and attenuate such injury . |
BACKGROUND | We describe the Carbon Control and Cardiac Arrest ( CCC ) trial . |
METHODS | The CCC trial is a pilot multicentre feasibility , safety and biological efficacy randomized controlled trial recruiting adult cardiac arrest patients admitted to the intensive care unit after return of spontaneous circulation . |
METHODS | At admission , using concealed allocation , participants are randomized to 24 h of either normocapnia ( PaCO2 35 to 45 mmHg ) or mild hypercapnia ( PaCO2 50 to 55 mmHg ) . |
METHODS | Key feasibility outcomes are recruitment rate and protocol compliance rate . |
METHODS | The primary biological efficacy and biological safety measures are the between-groups difference in serum neuron-specific enolase and S100b protein levels at 24 h , 48 h and 72 h. Secondary outcome measure include adverse events , in-hospital mortality , and neurological assessment at 6 months . |
CONCLUSIONS | The trial commenced in December 2012 and , when completed , will provide clinical evidence as to whether targeting mild hypercapnia for 24 h following intensive care unit admission for cardiac arrest patients is feasible and safe and whether it results in decreased concentrations of neurological injury biomarkers compared with normocapnia . |
CONCLUSIONS | Trial results will also be used to determine whether a phase IIb study powered for survival at 90 days is feasible and justified . |
BACKGROUND | Australian New Zealand Clinical Trials Registry ACTRN12612000690853 . |
###24226487 | null |
BACKGROUND | For decades thiopental has been considered as the hypnotic drug of choice for intracranial surgery . |
BACKGROUND | However , total intravenous anesthesia performed with thiopental is associated with delayed recovery , whereas early post-operative neurological evaluation is critical . |
BACKGROUND | For this reason , target controlled infusion ( TCI ) of propofol is increasingly used for maintenance of anesthesia . |
BACKGROUND | However , a thiopental TCI has never been assessed for this purpose . |
BACKGROUND | We tested the hypothesis that a thiopental TCI provides an acceptable way to achieve early recovery compared to a propofol TCI during supratentorial surgery . |
METHODS | Eighty patients undergoing elective craniotomy for a supratentorial tumor were randomized to receive either a propofol TCI ( group P ) or a thiopental TCI ( group T ) . |
METHODS | Both groups received a sufentanil TCI and the bispectral index was monitored . |
METHODS | The primary end-point was time to tracheal extubation . |
METHODS | Secondary end-points were per - and post-operative hemodynamics as well as respiratory and recovery parameters . |
METHODS | Assessment of study end-points was performed by an intensive care specialist blinded ( like the patient ) to the received hypnotic . |
RESULTS | Time to extubation was significantly ( P < 0.0001 ) shorter in group P ( median 149 minutes ; interquartile range 72-250 minutes ) than in group T ( median 453 minutes ; interquartile range 286-813 minutes ) . |
RESULTS | Similarly , the recovery parameters were significantly better in group P than in group T. |
RESULTS | There was no difference between groups in terms of patient characteristics and hemodynamic parameters . |
CONCLUSIONS | Even with TCI and bispectral index monitoring , thiopental is associated with an inappropriate delayed recovery from supratentorial surgery compared to propofol TCI . |
###25539560 | null |
OBJECTIVE | To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome . |
METHODS | Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study . |
METHODS | We divided these patients into 2 groups , whereby 32 ( 47 % ) patients received conservative therapy before arthroscopic subacromial decompression and 36 ( 53 % ) patients did not receive conservative therapy . |
METHODS | We compared both groups in terms of the the Constant , UCLA , and VAS scores for shoulder pain before and after arthroscopic subacromial decompression . |
RESULTS | Constant , UCLA , and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression ( P < 0.001 ) . |
RESULTS | Constant , UCLA , and VAS scores before arthroscopic subacromial decompression were statistically better in Group 1 than in Group 2 ( P < 0.001 ) . |
RESULTS | No statistically significant difference was found between the groups in terms of Constant , UCLA , and VAS scores after arthroscopic subacromial decompression ( P > 0.05 ) . |
CONCLUSIONS | Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression . |
###24401051 | null |
BACKGROUND | Obstructive sleep apnea is associated with considerable health risks . |
BACKGROUND | Although continuous positive airway pressure ( CPAP ) can mitigate these risks , effectiveness can be reduced by inadequate adherence to treatment . |
BACKGROUND | We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea . |
METHODS | Using a multicenter , prospective , single-group , cohort design , we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy . |
METHODS | The primary outcome measures were the apnea-hypopnea index ( AHI ; the number of apnea or hypopnea events per hour , with a score of 15 indicating moderate-to-severe apnea ) and the oxygen desaturation index ( ODI ; the number of times per hour of sleep that the blood oxygen level drops by 4 percentage points from baseline ) . |
METHODS | Secondary outcome measures were the Epworth Sleepiness Scale , the Functional Outcomes of Sleep Questionnaire ( FOSQ ) , and the percentage of sleep time with the oxygen saturation less than 90 % . |
METHODS | Consecutive participants with a response were included in a randomized , controlled therapy-withdrawal trial . |
RESULTS | The study included 126 participants ; 83 % were men . |
RESULTS | The mean age was 54.5 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 28.4 . |
RESULTS | The median AHI score at 12 months decreased 68 % , from 29.3 events per hour to 9.0 events per hour ( P < 0.001 ) ; the ODI score decreased 70 % , from 25.4 events per hour to 7.4 events per hour ( P < 0.001 ) . |
RESULTS | Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life . |
RESULTS | In the randomized phase , the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group ( 8.9 and 7.2 events per hour , respectively ) ; the AHI score was significantly higher ( indicating more severe apnea ) among the 23 participants in the therapy-withdrawal group ( 25.8 vs. 7.6 events per hour , P < 0.001 ) . |
RESULTS | The ODI results followed a similar pattern . |
RESULTS | The rate of procedure-related serious adverse events was less than 2 % . |
CONCLUSIONS | In this uncontrolled cohort study , upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea . |