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[PMID]:29348138
[Au] Autor:Jaja BNR; Saposnik G; Lingsma HF; Macdonald E; Thorpe KE; Mamdani M; Steyerberg EW; Molyneux A; Manoel ALO; Schatlo B; Hanggi D; Hasan D; Wong GKC; Etminan N; Fukuda H; Torner J; Schaller KL; Suarez JI; Stienen MN; Vergouwen MDI; Rinkel GJE; Spears J; Cusimano MD; Todd M; Le Roux P; Kirkpatrick P; Pickard J; van den Bergh WM; Murray G; Johnston SC; Yamagata S; Mayer S; Schweizer TA; Macdonald RL; SAHIT collaboration
[Ad] Endereço:Division of Neurosurgery, St Michael's Hospital, Toronto, ON, Canada.
[Ti] Título:Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study.
[So] Source:BMJ;360:j5745, 2018 01 18.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). DESIGN: Cohort study with logistic regression analysis to combine predictors and treatment modality. SETTING: Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries. PARTICIPANTS: Researchers collaborated to pool datasets of prospective observational studies, hospital registries, and randomised clinical trials of SAH from multiple geographical regions to develop and validate clinical prediction models. MAIN OUTCOME MEASURE: Predicted risk of mortality or functional outcome at three months according to score on the Glasgow outcome scale. RESULTS: Clinical prediction models were developed with individual patient data from 10 936 patients and validated with data from 3355 patients after development of the model. In the validation cohort, a core model including patient age, premorbid hypertension, and neurological grade on admission to predict risk of functional outcome had good discrimination, with an area under the receiver operator characteristics curve (AUC) of 0.80 (95% confidence interval 0.78 to 0.82). When the core model was extended to a "neuroimaging model," with inclusion of clot volume, aneurysm size, and location, the AUC improved to 0.81 (0.79 to 0.84). A full model that extended the neuroimaging model by including treatment modality had AUC of 0.81 (0.79 to 0.83). Discrimination was lower for a similar set of models to predict risk of mortality (AUC for full model 0.76, 0.69 to 0.82). All models showed satisfactory calibration in the validation cohort. CONCLUSION: The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. The predictor items are readily derived at hospital admission. The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients.
[Mh] Termos MeSH primário: Aneurisma Roto/complicações
Aneurisma Intracraniano/complicações
Avaliação de Resultados da Assistência ao Paciente
Medição de Risco/métodos
Hemorragia Subaracnóidea/mortalidade
[Mh] Termos MeSH secundário: Estudos de Coortes
Escala de Resultado de Glasgow
Seres Humanos
Estudos Observacionais como Assunto
Prognóstico
Estudos Prospectivos
Ensaios Clínicos Controlados Aleatórios como Assunto
Sistema de Registros
Reprodutibilidade dos Testes
Hemorragia Subaracnóidea/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5745


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[PMID]:27774844
[Au] Autor:Cheng K; Bassil R; Carandang R; Hall W; Muehlschlegel S
[Ad] Endereço:1 Department of Neurology, University of Massachusetts Medical School , Worcester, Massachusetts.
[Ti] Título:The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better?
[So] Source:J Neurotrauma;34(8):1603-1609, 2017 04 15.
[Is] ISSN:1557-9042
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Glasgow Coma Scale (GCS) has limited utility in intubated patients due to the inability to assign verbal subscores. The verbal subscore can be derived from the eye and motor subscores using a mathematical model, but the advantage of this method and its use in outcome prognostication in traumatic brain injury (TBI) patients remains unknown. We compared the validated "Core+CT"-IMPACT-model performance in 251 intubated TBI patients prospectively enrolled in the longitudinal OPTIMISM study between November 2009 and May 2015 when substituting the original motor GCS (mGCS) with the total estimated GCS (teGCS; with estimated verbal subscore). We hypothesized that model performance would improve with teGCS. Glasgow Outcome Scale (GOS) scores were assessed at 3 and 12 months by trained interviewers. In the complete case analysis, there was no statistically or clinically significant difference in the discrimination (C-statistic) at either time-point using the mGCS versus the teGCS (3 months: 0.893 vs. 0.871;12 months: 0.926 vs. 0.92). At 3 months, IMPACT-model calibration was excellent with mGCS and teGCS (Hosmer-Lemeshow "goodness-of-fit" chi square p value 0.9293 and 0.9934, respectively); it was adequate at 12 months with teGCS (0.5893) but low with mGCS (0.0158), possibly related to diminished power at 12 months. At both time-points, motor GCS contributed more to the variability of outcome (Nagelkerke ΔR ) than teGCS (3 months: 5.8% vs. 0.4%; 12 months: 5% vs. 2.6%). The sensitivity analysis with imputed missing outcomes yielded similar results, with improved calibration for both GCS variants. In our cohort of intubated TBI patients, there was no statistically or clinically meaningful improvement in the IMPACT-model performance by substituting the original mGCS with teGCS.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/diagnóstico
Escala de Coma de Glasgow/normas
Intubação Intratraqueal
Modelos Neurológicos
Índices de Gravidade do Trauma
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Escala de Resultado de Glasgow
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1089/neu.2016.4657


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[PMID]:29232812
[Au] Autor:Goedemans T; van den Munckhof P
[Ad] Endereço:Department of Neurosurgery, Amsterdam Medical Center, Amsterdam, The Netherlands.
[Ti] Título:In Reply to the Letter to the Editor Regarding "Neurologic Outcome After Decompressive Craniectomy: Predictors of Outcome in Different Pathologic Conditions".
[So] Source:World Neurosurg;109:504, 2018 01.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Craniectomia Descompressiva
Escala de Resultado de Glasgow
[Mh] Termos MeSH secundário: Lesões Encefálicas/cirurgia
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29232811
[Au] Autor:Ogando-Rivas E; Motolinia Alejandre RA
[Ad] Endereço:Department of Neurosurgery, University of Florida, Gainesville, Florida, USA. Electronic address: eogandorivas@ufl.edu.
[Ti] Título:Letter to the Editor Regarding "Neurologic Outcome After Decompressive Craniectomy: Predictors of Outcome in Different Pathologic Conditions".
[So] Source:World Neurosurg;109:503, 2018 01.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Craniectomia Descompressiva
Escala de Resultado de Glasgow
[Mh] Termos MeSH secundário: Lesões Encefálicas/cirurgia
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28459953
[Au] Autor:Mac Donald CL; Barber J; Jordan M; Johnson AM; Dikmen S; Fann JR; Temkin N
[Ad] Endereço:Department of Neurological Surgery, University of Washington, Seattle.
[Ti] Título:Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury.
[So] Source:JAMA Neurol;74(7):821-829, 2017 Jul 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden. Objectives: To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. Design, Setting, and Participants: This prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One- and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. Main Outcomes and Measures: Changes in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1- to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. Results: Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34 [8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended Glasgow Outcome Scale (GOS-E) at 5 years as a measure of overall disability identified brain injury diagnosis, preinjury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity at 1 year as risk factors for a poor outcome at 5 years, with an area under the curve of 0.92 indicating excellent prediction strength. Thirty-six of 50 patients with concussive blast TBI (72%) had a decline in the GOS-E from the 1- to 5-year evaluations, in contrast with only 5 of 44 combat-deployed controls (11%). Worsening of symptoms in concussive blast TBI was also observed on measures of posttraumatic stress disorder and depression. Service members with concussive blast TBI experienced evolution, not resolution, of symptoms from the 1- to 5-year outcomes. Conclusions and Relevance: Considerable decline was observed in military service members with concussive blast TBI when comparing 1- and 5-year clinical outcomes. These results advocate for new treatment strategies to combat the long-term and extremely costly effect of these wartime injuries.
[Mh] Termos MeSH primário: Sintomas Comportamentais/etiologia
Traumatismos por Explosões/complicações
Concussão Encefálica/complicações
Disfunção Cognitiva/etiologia
Escala de Resultado de Glasgow
Transtornos de Enxaqueca/etiologia
Militares
Avaliação de Resultados (Cuidados de Saúde)
[Mh] Termos MeSH secundário: Adulto
Campanha Afegã de 2001-
Estudos de Casos e Controles
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Prognóstico
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2017.0143


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[PMID]:29050383
[Au] Autor:Edlow BL; Chatelle C; Spencer CA; Chu CJ; Bodien YG; O'Connor KL; Hirschberg RE; Hochberg LR; Giacino JT; Rosenthal ES; Wu O
[Ad] Endereço:Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA, 02114, USA.
[Ti] Título:Early detection of consciousness in patients with acute severe traumatic brain injury.
[So] Source:Brain;140(9):2399-2414, 2017 Sep 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit. We prospectively enrolled 16 patients admitted to the intensive care unit for acute severe traumatic brain injury to test two hypotheses: (i) in patients who lack behavioural evidence of language expression and comprehension, functional magnetic resonance imaging and electroencephalography detect command-following during a motor imagery task (i.e. cognitive motor dissociation) and association cortex responses during language and music stimuli (i.e. higher-order cortex motor dissociation); and (ii) early responses to these paradigms are associated with better 6-month outcomes on the Glasgow Outcome Scale-Extended. Patients underwent functional magnetic resonance imaging on post-injury Day 9.2 ± 5.0 and electroencephalography on Day 9.8 ± 4.6. At the time of imaging, behavioural evaluation with the Coma Recovery Scale-Revised indicated coma (n = 2), vegetative state (n = 3), minimally conscious state without language (n = 3), minimally conscious state with language (n = 4) or post-traumatic confusional state (n = 4). Cognitive motor dissociation was identified in four patients, including three whose behavioural diagnosis suggested a vegetative state. Higher-order cortex motor dissociation was identified in two additional patients. Complete absence of responses to language, music and motor imagery was only observed in coma patients. In patients with behavioural evidence of language function, responses to language and music were more frequently observed than responses to motor imagery (62.5-80% versus 33.3-42.9%). Similarly, in 16 matched healthy subjects, responses to language and music were more frequently observed than responses to motor imagery (87.5-100% versus 68.8-75.0%). Except for one patient who died in the intensive care unit, all patients with cognitive motor dissociation and higher-order cortex motor dissociation recovered beyond a confusional state by 6 months. However, 6-month outcomes were not associated with early functional magnetic resonance imaging and electroencephalography responses for the entire cohort. These observations suggest that functional magnetic resonance imaging and electroencephalography can detect command-following and higher-order cortical function in patients with acute severe traumatic brain injury. Early detection of covert consciousness and cortical responses in the intensive care unit could alter time-sensitive decisions about withholding life-sustaining therapies.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/complicações
Lesões Encefálicas Traumáticas/fisiopatologia
Estado de Consciência/fisiologia
Diagnóstico Precoce
Estado Vegetativo Persistente/diagnóstico por imagem
Estado Vegetativo Persistente/fisiopatologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Lesões Encefálicas Traumáticas/diagnóstico por imagem
Estudos de Casos e Controles
Eletroencefalografia
Feminino
Escala de Coma de Glasgow
Escala de Resultado de Glasgow
Seres Humanos
Imaginação/fisiologia
Linguagem
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Música
Estado Vegetativo Persistente/etiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171021
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx176


  7 / 1657 MEDLINE  
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[PMID]:28886134
[Au] Autor:Jin J; Hu K; Zhou Y; Li W
[Ad] Endereço:Department of Pulmonary & Critical Care, West China Hospital, Sichuan University, Chengdu, China.
[Ti] Título:Clinical utility of the modified Glasgow prognostic score in lung cancer: A meta-analysis.
[So] Source:PLoS One;12(9):e0184412, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To perform a meta-analysis of prospective and retrospective studies exploring the association of the modified Glasgow prognostic score (mGPS) with overall survival (OS) in patients with lung cancer. METHODS: Relevant studies were identified by searching the Cochrane Library, Web of Science, Embase and PubMed until April 16, 2017. We combined hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between mGPS and OS in patients with lung cancer. RESULTS: Eleven studies involving 5817 participants from several countries were included in the meta-analysis. In a pooled analysis of all studies, elevated mGPS predicted poorer OS (HR = 1.77; 95% CI: 1.35-2.31; P<0.05). Subgroup analyses stratified by mGPS showed that mGPS of 1 or 2 and mGPS≥1 were predictive of poorer OS and that the HR for mGPS of 2 (HR = 5.82; 95% CI: 1.85-18.22; P = 0.003) was significantly greater than that for mGPS of 1 (HR = 1.74; 95% CI: 1.24-2.45; P = 0.001) and mGPS≥1 (HR = 1.42; 95% CI: 1.14-1.76; P = 0.002). Among patients undergoing surgery, elevated mGPS had a non-significant correlation with reduced OS (HR = 2.48; 95% CI: 0.90-6.85; P = 0.079), whereas the correlation was significant for patients receiving chemotherapy or other palliative treatment (HR = 1.74; 95% CI: 1.31-2.30; P<0.05). CONCLUSIONS: Our findings indicate that mGPS may have prognostic value in lung cancer, as we detected a significant association between elevated mGPS and poorer OS. The association between mGPS and poorer OS was non-significant among patients undergoing surgery, which may be attributable to lower tumor load. However, further studies are warranted to draw firm conclusions.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/diagnóstico
Neoplasias Pulmonares/mortalidade
[Mh] Termos MeSH secundário: Escala de Resultado de Glasgow
Seres Humanos
Prognóstico
Modelos de Riscos Proporcionais
Viés de Publicação
Índice de Gravidade de Doença
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184412


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[PMID]:28885354
[Au] Autor:Sulaiman T; Salazar L; Hasbun R
[Ad] Endereço:Department of Internal Medicine, Section of Infectious Diseases, UT Health McGovern Medical School, TX, USA.
[Ti] Título:Acute versus subacute community-acquired meningitis: Analysis of 611 patients.
[So] Source:Medicine (Baltimore);96(36):e7984, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Community-acquired meningitis can be classified into acute and subacute presentations by the duration of illness of ≤ or >5 days, respectively. There are currently no studies comparing the clinical features, management decisions, etiologies, and outcomes between acute and subacute presentations.It is a retrospective study of adults with community-acquired meningitis hospitalized in Houston, TX between January 2005 and January 2010. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of ≤4.A total of 611 patients were identified, of which 458 (75%) were acute and 153 subacute (25%). The most common etiologies were unknown in 418 (68.4%), viral in 94 (15.4%), bacterial in 47 (7.7%), fungal in 42 patients (6.9%), and other noninfectious etiologies in 6 (1%). Patients with subacute meningitis were more likely to be immunosuppressed or have comorbidities, had fungal etiologies, and had higher rates of hypoglycorrachia and abnormal neurological findings (P <.05). Patients with an acute presentation were more likely to be treated empirically with intravenous antibiotics and had higher cerebrospinal fluid pleocytosis and serum white blood cell counts (P <.05). On logistic regression, age >65 years and abnormal neurological findings were predictive of an adverse clinical outcome in both acute and subacute meningitis, whereas fever was also a significant prognostic factor in acute meningitis. (P <.05).Acute and subacute meningitis differ in regards to clinical presentations, etiologies, laboratory findings, and management decisions, but did not differ in rates of adverse clinical outcomes. Future studies including thoroughly investigated patients with new diagnostic molecular methods may show different results and outcomes.
[Mh] Termos MeSH primário: Meningite/fisiopatologia
Meningite/terapia
[Mh] Termos MeSH secundário: Doença Aguda
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Infecções Comunitárias Adquiridas/epidemiologia
Infecções Comunitárias Adquiridas/etiologia
Infecções Comunitárias Adquiridas/fisiopatologia
Infecções Comunitárias Adquiridas/terapia
Feminino
Escala de Resultado de Glasgow
Seres Humanos
Modelos Logísticos
Masculino
Meningite/epidemiologia
Meningite/etiologia
Meia-Idade
Estudos Retrospectivos
Texas
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007984


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[PMID]:28816934
[Au] Autor:Wan J; Zhang L; Lu G; Gu W; Huang L; Ge L; Zhang X; Ji L; Chen Q; Di R; Jiang Y
[Ad] Endereço:aDepartment of Interventional Radiology, Jing'an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing'an Branch bDepartment of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
[Ti] Título:Midterm outcomes of intracranial aneurysms with bleb formation with densely coiling of the aneurismal neck or entire aneurysm.
[So] Source:Medicine (Baltimore);96(33):e7046, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To evaluate whether the efficacy and safety of embolization of the aneurysmal neck were better than those of embolization of the entire aneurysm. Previous studies found that embolization of the aneurysmal neck can be used for treating ruptured intracranial aneurysm with bleb formation.In all, 163 patients with ruptured aneurysms with bleb formation who underwent endovascular embolization at the Shanghai Municipal Jing'an District Central Hospital from January 2014 to August 2015 were divided into the embolization of aneurysmal neck group (neck group; 87 cases) and embolization of entire aneurysm group (aneurysm group; 76 cases). A retrospective analysis of clinical data, follow-up Glasgow Outcome Scale (GOS) score, and occurrence of complications was performed. The impacts of different embolisms on the prognosis were compared.The median follow-up time in the neck and aneurysm groups was 17 months (9.62) and 16.5 months (9.54), respectively (P = .799). No differences were found in recurrence, postoperative GOS score, and GOS score at the last follow-up between the 2 groups. The numbers of coils and surgical complications in the neck group were smaller than those in the aneurysm group (P < .001 and P < .030, respectively). After adjusting for age and sex, the embolization method was found to be an independent predictor for surgery-related complications (odds ratio 2.419, 95% confidence interval 1.111-5.269, P = .026).The numbers of coils and surgery-related complications were smaller when embolizing the aneurysmal neck than the entire aneurysm, showing potential advantages of embolization of the aneurysmal neck.
[Mh] Termos MeSH primário: Aneurisma Roto/terapia
Embolização Terapêutica/métodos
Aneurisma Intracraniano/terapia
[Mh] Termos MeSH secundário: Adulto
Vesícula
China
Feminino
Escala de Resultado de Glasgow
Seres Humanos
Aneurisma Intracraniano/complicações
Masculino
Meia-Idade
Prognóstico
Recidiva
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007046


  10 / 1657 MEDLINE  
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[PMID]:28787296
[Au] Autor:Enger TB; Philipp A; Lubnow M; Fischer M; Camboni D; Lunz D; Bein T; Müller T
[Ad] Endereço:1Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 2Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany. 3Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. 4Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
[Ti] Título:Long-Term Survival in Adult Patients With Severe Acute Lung Failure Receiving Veno-Venous Extracorporeal Membrane Oxygenation.
[So] Source:Crit Care Med;45(10):1718-1725, 2017 Oct.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess long-term survival in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation and explore risk factors for long-term mortality. DESIGN: Single-center prospective cohort study. SETTING: University Hospital Regensburg, Germany. PATIENTS: All primary cases supported with veno-venous extracorporeal membrane oxygenation from 2007 to 2016 (n = 553). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were followed until January 2017. Long-term survival and predictors of long-term mortality were assessed using Kaplan-Meier survival analyses and Cox proportional hazards modeling, respectively. Two hundred eighty-six patients (52%) died during follow-up (mean follow-up 4.8 yr). Two hundred seventeen patients (39%) died during hospitalization, whereas another 69 patients (12%) died during later follow-up. Among hospital survivors, the 1-month, 3-month, 1-year, and 5-year survival rates were 99%, 95%, 86%, and 76%, respectively. Higher age, immunocompromised status, and higher Sequential Organ Failure Assessment scores were associated with long-term mortality, whereas patients with out-of-center cannulation showed improved long-term survival. Due to nonproportional hazards over time, the analysis was repeated for hospital survivors only (n = 336). Only age and immunocompromised state remained significant predictors of late mortality among hospital survivors. Lower Glasgow Outcome Scale at hospital discharge and the University Hospital Regensburg pre-extracorporeal membrane oxygenation score for predicting hospital mortality in veno-venous extracorporeal membrane oxygenation patients before extracorporeal membrane oxygenation initiation were associated with late mortality in hospital survivors (p < 0.001). CONCLUSIONS: Whereas acute illness factors may be important in prediction of hospital outcomes in veno-venous extracorporeal membrane oxygenation patients, they do not determine late mortality in hospital survivors. Preexisting morbidity and functional ability at hospital discharge may be important determinants of long-term survival in veno-venous extracorporeal membrane oxygenation patients.
[Mh] Termos MeSH primário: Oxigenação por Membrana Extracorpórea
Insuficiência Respiratória/mortalidade
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Estudos de Coortes
Feminino
Seguimentos
Alemanha/epidemiologia
Escala de Resultado de Glasgow
Seres Humanos
Hospedeiro Imunocomprometido
Masculino
Meia-Idade
Escores de Disfunção Orgânica
Insuficiência Respiratória/terapia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002644



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