BACKGROUND Acoustic radiation force impulse(ARFI)is used to measure liver fibrosis and predict outcomes.The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus(HBV)than in other etiolo...BACKGROUND Acoustic radiation force impulse(ARFI)is used to measure liver fibrosis and predict outcomes.The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus(HBV)than in other etiologies of chronic liver disease.AIM To evaluate the performance of ARFI in long-term outcome prediction among different etiologies of chronic liver disease.METHODS Consecutive patients who received an ARFI study between 2011 and 2018 were enrolled.After excluding dual infection,alcoholism,autoimmune hepatitis,and others with incomplete data,this retrospective cohort were divided into hepatitis B(HBV,n=1064),hepatitis C(HCV,n=507),and non-HBV,non-HCV(NBNC,n=391)groups.The indexed cases were linked to cancer registration(1987-2020)and national mortality databases.The differences in morbidity and mortality among the groups were analyzed.RESULTS At the enrollment,the HBV group showed more males(77.5%),a higher prevalence of prediagnosed hepatocellular carcinoma(HCC),and a lower prevalence of comorbidities than the other groups(P<0.001).The HCV group was older and had a lower platelet count and higher ARFI score than the other groups(P<0.001).The NBNC group showed a higher body mass index and platelet count,a higher prevalence of pre-diagnosed non-HCC cancers(P<0.001),especially breast cancer,and a lower prevalence of cirrhosis.Male gender,ARFI score,and HBV were independent predictors of HCC.The 5-year risk of HCC was 5.9%and 9.8%for those ARFI-graded with severe fibrosis and cirrhosis.ARFI alone had an area under the receiver operating characteristic curve(AUROC)of 0.742 for prediction of HCC in 5 years.AUROC increased to 0.828 after adding etiology,gender,age,and platelet score.No difference was found in mortality rate among the groups.CONCLUSION The HBV group showed a higher prevalence of HCC but lower comorbidity that made mortality similar among the groups.Those patients with ARFI-graded severe fibrosis or cirrhosis should receive regular surveillance.展开更多
BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of p...BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of patients with multiple malignancies was recently reported.However,pCCA is one of the most surgically difficult gastrointestinal tumors with the poorest prognosis,and the value of the ACCI for the prognosis of pCCA patients after curative resection is unclear.AIM To evaluate the prognostic value of the ACCI and to design an online clinical model for pCCA patients.METHODS Consecutive pCCA patients after curative resection between 2010 and 2019 were enrolled from a multicenter database.The patients were randomly assigned 3:1 to training and validation cohorts.In the training and validation cohorts,all patients were divided into low-,moderate-,and high-ACCI groups.Kaplan-Meier curves were used to determine the impact of the ACCI on overall survival(OS)for pCCA patients,and multivariate Cox regression analysis was used to determine the independent risk factors affecting OS.An online clinical model based on the ACCI was developed and validated.The concordance index(C-index),calibration curve,and receiver operating characteristic(ROC)curve were used to evaluate the predictive performance and fit of this model.RESULTS A total of 325 patients were included.There were 244 patients in the training cohort and 81 patients in the validation cohort.In the training cohort,116,91 and 37 patients were classified into the low-,moderate-and high-ACCI groups.The Kaplan-Meier curves showed that patients in the moderate-and high-ACCI groups had worse survival rates than those in the low-ACCI group.Multivariable analysis revealed that moderate and high ACCI scores were independently associated with OS in pCCA patients after curative resection.In addition,an online clinical model was developed that had ideal C-indexes of 0.725 and 0.675 for predicting OS in the training and validation cohorts.The calibration curve and ROC curve indicated that the model had a good fit and prediction performance.CONCLUSION A high ACCI score may predict poor long-term survival in pCCA patients after curative resection.High-risk patients screened by the ACCI-based model should be given more clinical attention in terms of the management of comorbidities and postoperative follow-up.展开更多
BACKGROUND Persistent left superior vena cava(PLSVC)is the most common venous system variant.The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.AIM To deve...BACKGROUND Persistent left superior vena cava(PLSVC)is the most common venous system variant.The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.AIM To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC.METHODS Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied.The clinical characteristics of the pregnant women,ultrasonic imaging information,gestational age at diagnosis,pregnancy outcomes,and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher’s exact test.RESULTS Of the 97 cases diagnosed by prenatal ultrasound,49(50.5%)had isolated PLSVC and 48(49.5%)had other structural abnormalities.The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant(P<0.05).No significant differences were identified between the two groups in terms of advanced maternal age and gestational age(P>0.05).According to the results of the classification statistics,the most common intrac-ardiac abnormality was a ventricular septal defect and the most common extrac-ardiac abnormality was a single umbilical artery.In the subgroup analysis,the concurrent combination of intra-and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes(odds ratio>1,P<0.05).Additional-ly,all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group.One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication.CONCLUSION Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed.Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnor-malities.Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.展开更多
We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic ste...We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We identified the prognostic factors of disease-free survival(DFS)in a training subset(n=593),then assigned a weighted score using these factors to the remaining patients(validation subset;n=296).The multivariable model identified two independent predictors of DFS:DRI and HCT-CI before transplantation.In this scoring system,we assigned a weighted score of 2 to very high-risk DRI,and assigned a weighted score of 1 to high-risk DRI and intermediate-and high-risk HCT-CI(i.e.,haplo-DRCI).In the validation cohort,the three-year DFS rate was 65.2%(95%confidence interval(CI),58.2%–72.2%),55.8%(95%CI,44.9%–66.7%),and 32.0%(95%CI,5.8%–58.2%)for the low-,intermediate-,and high-risk group,respectively(P=0.005).Haplo-DRCI can also predict DFS in disease-specific subgroups,particularly in acute leukemia patients.Increasing score was also significantly predictive of increased relapse,increased non-relapse mortality(NRM),decreased DFS,and decreased overall survival(OS)in an independent historical cohort(n=526).These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT.展开更多
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosin...Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents.This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders,learning disorders,externalising and internalising disorders.Challenges in screening for,diagnosing and managing comorbidity with ADHD are summarised.Also,methodological challenges and future directions in research in this interesting field are highlighted.展开更多
Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of BD.The...Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of BD.The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses(n=103),epidemiological surveys,and large-scale clinical studies.The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time.All types of anxiety disorders were equally common in BD.However,there was a wide variation in rates across different sources,with most of this discrepancy being accounted for by methodological differences between reports.Comorbid anxiety disorders negatively impacted the presentation and course of BD.This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD.Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD.Nevertheless,the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.展开更多
Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistanc...Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine(or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.展开更多
Objective:To review trials on mindfulness intervention for chronic pain in primary care to clarify the evidence base and establish whether mindfulness is an important intervention for relieving pain and improving psyc...Objective:To review trials on mindfulness intervention for chronic pain in primary care to clarify the evidence base and establish whether mindfulness is an important intervention for relieving pain and improving psychological comorbidity.Methods:We performed a literature search using PubMed,the Cochrane Database,EBSCOhost,Elsevier,Wiley,Springer,and the references of retrieved articles.We included articles written in English and that were published up to January 2012.We found 428 empirical studies,but only eight were included as randomized controlled trials of mindfulness intervention for chronic pain in our meta-analysis.After extracting and synthesizing data from these eight trials,we analyzed the data extracted and synthesized from these eight trials.Results:Compared with control intervention,mindfulness intervention had no specific effect on reducing pain intensity(weighted mean difference 3.24,95%confidence interval[CI]:8.92 to 2.45).Mindfulness intervention led to greater improvement in psychological comorbidity with chronic pain,such as depression(weighted mean difference3.91,95%CI5.94 to2.32)and trait anxiety(weighted mean difference4.07,95%CI4.48 to3.65).Conclusion:There is insufficient evidence that mindfulness intervention relieves pain intensity.However,it improves depression and trait anxiety in patients with chronic pain.Further research in larger,properly powered,and better-designed studies is warranted.展开更多
BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality di...BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality disorders(PD),which are especially common in individuals with high-functioning ASD where there is less need for support.AIM To summarize the research findings on PD in adults with ASD and without intellectual disability,focusing on comorbidity and differential diagnosis.METHODS PubMed searches were performed using the key words“Asperger’s Syndrome”,“Autism”,“Personality”,“Personality disorder”and“comorbidity”in order to identify relevant articles published in English.Grey literature was identified through searching Google Scholar.The literature reviews and reference sections of selected papers were also examined for additional potential studies.The search was restricted to studies published up to April 2020.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria:16 evaluated personality profiles or PD in ASD(comorbidity),five compared ASD and PD(differential diagnosis)and one performed both tasks.There were significant differences in the methodological Cluster A and cluster C PD are the most frequent co-occurring PD,but overlapping features should be considered.Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists.Further studies are needed to explore the complex relationship between ASD and PD.展开更多
Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psori...Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.展开更多
BACKGROUND The lack of space,as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms,remains con...BACKGROUND The lack of space,as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms,remains controversial.AIM To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with autosomal dominant polycystic kidney disease.METHODS One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without(kidney transplant alone(KTA)group)and 77 with associated ipsilateral nephrectomy(KTIN group),were retrospectively reviewed.Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.RESULTS Creation of space for future graft positioning was the main reason(n=74,96.1%)for associated ipsilateral nephrectomy.No significant difference in surgical comorbidity(lymphocele,wound infection,incisional hernia,wound hematoma,urinary infection,need for blood transfusion,hospitalization stay,Dindo Clavien classification and readmission rate)was observed between the two study groups.The incidence of primary nonfunction and delayed graft function was comparable in both groups[0%and 2.6%(P=0.497)and 9.1%and 16.9%(P=0.230),respectively,in the KTA and KTIN group].The 1-and 5-year graft survival were 94.8%and 90.3%,and 100%and 93.8%,respectively,in the KTA and KTIN group(P=0.774).The 1-and 5-year patient survival were 96.1%and 92.9%,and 100%and 100%,respectively,in the KTA and KTIN group(P=0.168).CONCLUSION Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with autosomal dominant polycystic kidney disease does not negatively impact surgical comorbidity and short-and long-term graft survival.展开更多
Cirrhosis patients’comorbidities are their other diseases than cirrhosis.Comorbidities are neither causes nor consequences of cirrhosis,but they can increase mortality and are therefore clinically important.They are ...Cirrhosis patients’comorbidities are their other diseases than cirrhosis.Comorbidities are neither causes nor consequences of cirrhosis,but they can increase mortality and are therefore clinically important.They are also an important source of confounding in epidemiologic studies.Comorbidity scoring systems have been developed as tools to measure the cirrhosis patient’s total burden of comorbidity,and they are useful in the clinic and for epidemiologic studies.The recently developed CirCom score is the only comorbidity scoring system developed specifically for cirrhosis patients,and it may be preferred over the older,generic,and more complex Charlson comorbidity index.Studies of individual comorbid diseases can provide insight into the interactions between cirrhosis and other diseases and thus into the pathophysiology of cirrhosis.This article reviews the literature on comorbidity in cirrhosis.展开更多
BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has be...BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,P<0.001;median 4(IQR 3-5)vs 5(IQR 4-6.5)d,P=0.005,respectively.Following multivariable analysis,the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function;in addition the dichotomous variables of age over75 years and ACCI more than 7 were significant predictors of hospital stay.No outcomes were significantly associated with Clavien-Dindo grading.Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS(median6-IQR 5-8-vs 7-IQR 6-12-d,P=0.013)and later TFF(median 2-IQR 1-3-vs 3-IQR 2-4-d,P=0.008),while patients with ACCI more than 7 were only associated with a prolonged hospital stay(median 7-IQR 5-8-vs 7-IQR 6-14.5-d,P=0.036).CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach,but older age and several comorbidities tend to reduce its benefits.展开更多
Aim: The aim of this study was to investigate the impact of war on children and comorbidity of post traumatic stress disorder, attention deficit with hyperactivity, conduct, and oppositional defiant disorder in Palest...Aim: The aim of this study was to investigate the impact of war on children and comorbidity of post traumatic stress disorder, attention deficit with hyperactivity, conduct, and oppositional defiant disorder in Palestinian children. Methods: The study was conducted in the entire Gaza Strip 6 months after the end of the war on Gaza that lasted for 23 days. The study sample included 410 children aged 6 to 17 years. Children completed measures of experience of traumatic events (Gaza Traumatic Checklist-War on Gaza), post traumatic stress disorder index, attention deficit with hyperactivity scale for parents and self, conduct disorder scale, and oppositional defiant disorder. Results: Palestinians children investigated 6 months after the war on Gaza still reported traumatic experiences: 94.6% heard the sonic sounds of the jet fighters, 91.7% heard shelling of the area by artillery, 92% watched mutilated bodies on television, 80% were deprived from water or electricity during the war, 50.7% said they left home for safer place. Using Diagnostic Manual of Mental Disorders-IV (DSM-IV) criteria for post traumatic stress disorder, 25.1% of children reported no psychological reactions, 25.9% of children reported one criteria, 39.3% of children reported partial post traumatic stress disorder and 9.8% of children reported full criteria for post traumatic stress disorder. According to the parents’ report, the results showed 31.3% of children met the criteria for inattentive type, 36.3% of children were impulsive and 29% met criteria for combined type. According to the children’s report, the results showed 28.8% of children met the criteria for inattentive type, 37.3% of children were impulsive and 28.3% met criteria for combined type. Using DSM-IV diagnostic criteria of conduct disorder and oppositional defiant disorder, the study showed that 38.1% of parents reported conduct disorder in their children and 46.3% reported oppositional defiant disorder. While 39.3% of children themselves reported conduct disorder and 44% of them reported oppositional defiant disorder. The study showed that 5.1% of children had comorbidity of post traumatic stress disorder and attention deficit disorder, 4.4% had comorbidity of post traumatic stress disorder and impulsivity-hyperactivity disorder, and 4.4% had comorbidity of post traumatic stress disorder and attention deficit with hyperactivity combined type. Also, 4.6% of children had comorbidity of conduct and post traumatic stress disorder and 6.1% had comorbidity of oppositional defiant disorder and post traumatic stress disorder. Conclusions: This study revealed that children living in areas of conflict and war are the main group at risk of developing post traumatic stress disorder and other behavioral problems including attention deficit with hyperactivity, conduct, and oppositional defiant disorder, and the internationallaws must protect the civilians during the conflict, establishing safe havens for children and their families to decrease the effect of war on children.展开更多
Objective: To investigate the potential comorbidity biomarkers for Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s disease (AD). Methods: This is a randomized case-control study. There are three groups: 1) normal con...Objective: To investigate the potential comorbidity biomarkers for Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s disease (AD). Methods: This is a randomized case-control study. There are three groups: 1) normal control group included 32 healthy elderly people in the hospital physical examination;2) 30 patients with T2DM group;and 3) AD group has 28 cases. On-line reversed-phase liquid chromatography separation, tandem mass spectrometry analysis and iTRAQ quantification were used for identification of peptidomic analysis, then detection of three comorbidity biomarkers might be associated with T2DM and AD by ELISA. Results: The Peptidomic Analysis of the potential comorbidity biomarkers for T2DM and the AD group includes Osteopontin (OPN), Isoform 2 of Histone H2Btype 2-F and Histone H4. These potential comorbidity biomarkers for T2DM and the AD group are significantly increased than normal control group. OPN concentrations are 1.67 (0.13 - 2.63) mmol/L in the normal control group, 3.15 (1.51 - 5.35) mmol/L in the T2DM group, and 7.66 (3.55 - 15.38) mmol/L in the AD group. Histone H4 concentrations in three groups respectively are 0.21 ± 0.036 mmol/L (normal control), 0.21 ± 0.046 mmol/L (T2DM) and 0.21 ± 0.034 mmol/L(AD). Isoforms 2 of Histone H2Btype 2-F are 1.73 (0.12 - 2.60) mmol/L, 4.71 (1.26 - 6.84) mmol/L and 9.30 (0 - 20.8) mmol/Lin three groups respectively. Conclusion: The inflammatory mechanism may lead to an increase of histone content in the urine of AD and T2DM patients. Clinical test of these potential comorbidity biomarkers Histones and Osteopontin would be the diagnosis of comorbidity AD and T2DM.展开更多
Introduction: Abdominal deposition of fat has been described as the type of obesity that offers the greatest risk for the health of individuals, and is associated with increased mortality, and morbidity. Conicity inde...Introduction: Abdominal deposition of fat has been described as the type of obesity that offers the greatest risk for the health of individuals, and is associated with increased mortality, and morbidity. Conicity index (Ci), Body mass index (BMI), and waist hip ratio (WHR) are used to predict the risk of obesity related diseases. However, it has not been ex amined whether these indicators can predict the comorbidities in hemodialysis subjects in Lebanon. Objective: to determine the effect of central obesity on comorbidities in hemodialysis patients in Lebanon. Material and Method: This is a cross-sectional study of obesity in 60 hemodialysis subjects in Lebanon. A linear regression analysis was used to determine the relationship between BMI, Ci, WHR, and comorbidities measured by Charlson (CCI) and Davies comorbidities indexes. Results: Ci values were significantly associated with age, and CCI;the abdominal fat deposition evaluated by the conicity index and WHR were a predictor of the comorbidities according to CCI (= 2.96;p = 0.01), and Davies comorbidity index (= 1.19;p = 0.05) scores. BMI was a weak predictor of comorbidity. Conclusion: Abdominal obesity by using simple anthropometric measurements e.g. Ci, and WHR values can similarly predict the presence of comorbidities in hemodialysis patients. Maintaining appropriate Ci and WHR values might be important to improve outcome in hemodialysis patients.展开更多
AIM To explore the effect of primary liver disease and comorbidities on transplant length of stay(TLOS) and LOS in later admissions in the first two years after liver transplantation(LLOS). METHODS A linked United Kin...AIM To explore the effect of primary liver disease and comorbidities on transplant length of stay(TLOS) and LOS in later admissions in the first two years after liver transplantation(LLOS). METHODS A linked United Kingdom Liver Transplant Audit- Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in Englandwas analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS In 3772 patients, the mean(95%CI) TLOS was 24.8(24.2 to 25.5) d, and the mean LLOS was 24.2(22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group(6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group(14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d(5.7 to 11.3) longer TLOS and 6.0 d(0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS.CONCLUSION The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS.展开更多
The prevalence of persons with social anxiety disorder (SAD) in Japan remains unknown. This study examined 293 patients with age between 20 and 60 at first visit on the outpatient clinic of psychiatry by the section o...The prevalence of persons with social anxiety disorder (SAD) in Japan remains unknown. This study examined 293 patients with age between 20 and 60 at first visit on the outpatient clinic of psychiatry by the section of social phobia of M.I.N.I. and DSM-IV. After that, 10 patients with both SAD out of 16 patients (trial recruited) completed 12 weeks of treatment with paroxetine. Among 63 patients with 4 points and 40 patients with 3 points on the M.I.N.I., 21 patients (33%) and 16 patients (40%) were diagnosed as SAD on DSM-IV criteria, respectively. Together, 37 patients (12.6%) were diagnosed as SAD out of the 293 outpatients. Among 37 patients with SAD, 23 patients (62%) had comorbid depression. As for 10 patients after treatment with paroxetine, 8 patients improved from the point of recovery of depression (HAM-D scores below 10), whereas only 4 patients improved from the point of recovery of social phobia (L-SAS scores below 30). Three points as well as 4 points on the M.I.N.I. is meaningful for the diagnosis of SAD. For a while, paroxetine exerted less beneficial effects on SAD rather than on depression.展开更多
The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Verg...The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Vergata University. 38 patients out of 86 (44.2%) presented one or more psychiatric comorbidities, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychotic symptoms. We compared our sample with the evidences from the scientific literature on psychiatric comorbidity in ASD patient, in particular in HFA/AS. In this paper we focus on the high frequency of comorbid psychiatric disorders in HFA/AS patients, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychosis, including schizophrenia. We analyzed rates of all psichiatric comorbidities diagnosed in a sample of HFA/AS subjects and we compared findings from our study with the evidences from the scientific literature on psychiatric comorbidity in ASD patients, in particular HFA/AS. We point out that comorbid psychiatric symptoms can be hardly diagnosed, because they could present atipically in ASDs then in general population. Furthermore, they could be masked by ASD core symptoms.展开更多
基金Supported by the Chang Gung Memorial Hospital and PAII Inc.(a United States subsidiary company of Ping An Insurance Group),No.SMRPG3I0011.
文摘BACKGROUND Acoustic radiation force impulse(ARFI)is used to measure liver fibrosis and predict outcomes.The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus(HBV)than in other etiologies of chronic liver disease.AIM To evaluate the performance of ARFI in long-term outcome prediction among different etiologies of chronic liver disease.METHODS Consecutive patients who received an ARFI study between 2011 and 2018 were enrolled.After excluding dual infection,alcoholism,autoimmune hepatitis,and others with incomplete data,this retrospective cohort were divided into hepatitis B(HBV,n=1064),hepatitis C(HCV,n=507),and non-HBV,non-HCV(NBNC,n=391)groups.The indexed cases were linked to cancer registration(1987-2020)and national mortality databases.The differences in morbidity and mortality among the groups were analyzed.RESULTS At the enrollment,the HBV group showed more males(77.5%),a higher prevalence of prediagnosed hepatocellular carcinoma(HCC),and a lower prevalence of comorbidities than the other groups(P<0.001).The HCV group was older and had a lower platelet count and higher ARFI score than the other groups(P<0.001).The NBNC group showed a higher body mass index and platelet count,a higher prevalence of pre-diagnosed non-HCC cancers(P<0.001),especially breast cancer,and a lower prevalence of cirrhosis.Male gender,ARFI score,and HBV were independent predictors of HCC.The 5-year risk of HCC was 5.9%and 9.8%for those ARFI-graded with severe fibrosis and cirrhosis.ARFI alone had an area under the receiver operating characteristic curve(AUROC)of 0.742 for prediction of HCC in 5 years.AUROC increased to 0.828 after adding etiology,gender,age,and platelet score.No difference was found in mortality rate among the groups.CONCLUSION The HBV group showed a higher prevalence of HCC but lower comorbidity that made mortality similar among the groups.Those patients with ARFI-graded severe fibrosis or cirrhosis should receive regular surveillance.
基金Supported by National Natural Science Foundation of China,No. 81874211Chongqing Technology Innovation and Application Development Special Key Project,No. CSTC2021jscx-gksb-N0009
文摘BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of patients with multiple malignancies was recently reported.However,pCCA is one of the most surgically difficult gastrointestinal tumors with the poorest prognosis,and the value of the ACCI for the prognosis of pCCA patients after curative resection is unclear.AIM To evaluate the prognostic value of the ACCI and to design an online clinical model for pCCA patients.METHODS Consecutive pCCA patients after curative resection between 2010 and 2019 were enrolled from a multicenter database.The patients were randomly assigned 3:1 to training and validation cohorts.In the training and validation cohorts,all patients were divided into low-,moderate-,and high-ACCI groups.Kaplan-Meier curves were used to determine the impact of the ACCI on overall survival(OS)for pCCA patients,and multivariate Cox regression analysis was used to determine the independent risk factors affecting OS.An online clinical model based on the ACCI was developed and validated.The concordance index(C-index),calibration curve,and receiver operating characteristic(ROC)curve were used to evaluate the predictive performance and fit of this model.RESULTS A total of 325 patients were included.There were 244 patients in the training cohort and 81 patients in the validation cohort.In the training cohort,116,91 and 37 patients were classified into the low-,moderate-and high-ACCI groups.The Kaplan-Meier curves showed that patients in the moderate-and high-ACCI groups had worse survival rates than those in the low-ACCI group.Multivariable analysis revealed that moderate and high ACCI scores were independently associated with OS in pCCA patients after curative resection.In addition,an online clinical model was developed that had ideal C-indexes of 0.725 and 0.675 for predicting OS in the training and validation cohorts.The calibration curve and ROC curve indicated that the model had a good fit and prediction performance.CONCLUSION A high ACCI score may predict poor long-term survival in pCCA patients after curative resection.High-risk patients screened by the ACCI-based model should be given more clinical attention in terms of the management of comorbidities and postoperative follow-up.
文摘BACKGROUND Persistent left superior vena cava(PLSVC)is the most common venous system variant.The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.AIM To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC.METHODS Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied.The clinical characteristics of the pregnant women,ultrasonic imaging information,gestational age at diagnosis,pregnancy outcomes,and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher’s exact test.RESULTS Of the 97 cases diagnosed by prenatal ultrasound,49(50.5%)had isolated PLSVC and 48(49.5%)had other structural abnormalities.The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant(P<0.05).No significant differences were identified between the two groups in terms of advanced maternal age and gestational age(P>0.05).According to the results of the classification statistics,the most common intrac-ardiac abnormality was a ventricular septal defect and the most common extrac-ardiac abnormality was a single umbilical artery.In the subgroup analysis,the concurrent combination of intra-and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes(odds ratio>1,P<0.05).Additional-ly,all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group.One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication.CONCLUSION Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed.Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnor-malities.Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.
基金This work was supported by the National Key Research and Development Program of China(2017YFA0104500)the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81621001)+6 种基金the Key Program of the National Natural Science Foundation of China(81930004)Capital’s Funds for Health Improvement and Research(2018-4-4089)CAMS Innovation Fund for Medical Sciences(CIFMS)(2019-I2M-5-034)the Science and Technology Project of Guangdong Province of China(2016B030230003)the Project of Health Collaborative Innovation of Guangzhou City(201704020214)Peking University Clinical Scientist Program(BMU2019LCKXJ003)supported by the Fundamental Research Funds for the Central Universities.
文摘We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We identified the prognostic factors of disease-free survival(DFS)in a training subset(n=593),then assigned a weighted score using these factors to the remaining patients(validation subset;n=296).The multivariable model identified two independent predictors of DFS:DRI and HCT-CI before transplantation.In this scoring system,we assigned a weighted score of 2 to very high-risk DRI,and assigned a weighted score of 1 to high-risk DRI and intermediate-and high-risk HCT-CI(i.e.,haplo-DRCI).In the validation cohort,the three-year DFS rate was 65.2%(95%confidence interval(CI),58.2%–72.2%),55.8%(95%CI,44.9%–66.7%),and 32.0%(95%CI,5.8%–58.2%)for the low-,intermediate-,and high-risk group,respectively(P=0.005).Haplo-DRCI can also predict DFS in disease-specific subgroups,particularly in acute leukemia patients.Increasing score was also significantly predictive of increased relapse,increased non-relapse mortality(NRM),decreased DFS,and decreased overall survival(OS)in an independent historical cohort(n=526).These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT.
文摘Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents.This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders,learning disorders,externalising and internalising disorders.Challenges in screening for,diagnosing and managing comorbidity with ADHD are summarised.Also,methodological challenges and future directions in research in this interesting field are highlighted.
文摘Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of BD.The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses(n=103),epidemiological surveys,and large-scale clinical studies.The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time.All types of anxiety disorders were equally common in BD.However,there was a wide variation in rates across different sources,with most of this discrepancy being accounted for by methodological differences between reports.Comorbid anxiety disorders negatively impacted the presentation and course of BD.This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD.Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD.Nevertheless,the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.
文摘Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine(or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.
基金supported by Nantong Science and Technology Information Bureau(HS2012046).
文摘Objective:To review trials on mindfulness intervention for chronic pain in primary care to clarify the evidence base and establish whether mindfulness is an important intervention for relieving pain and improving psychological comorbidity.Methods:We performed a literature search using PubMed,the Cochrane Database,EBSCOhost,Elsevier,Wiley,Springer,and the references of retrieved articles.We included articles written in English and that were published up to January 2012.We found 428 empirical studies,but only eight were included as randomized controlled trials of mindfulness intervention for chronic pain in our meta-analysis.After extracting and synthesizing data from these eight trials,we analyzed the data extracted and synthesized from these eight trials.Results:Compared with control intervention,mindfulness intervention had no specific effect on reducing pain intensity(weighted mean difference 3.24,95%confidence interval[CI]:8.92 to 2.45).Mindfulness intervention led to greater improvement in psychological comorbidity with chronic pain,such as depression(weighted mean difference3.91,95%CI5.94 to2.32)and trait anxiety(weighted mean difference4.07,95%CI4.48 to3.65).Conclusion:There is insufficient evidence that mindfulness intervention relieves pain intensity.However,it improves depression and trait anxiety in patients with chronic pain.Further research in larger,properly powered,and better-designed studies is warranted.
文摘BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality disorders(PD),which are especially common in individuals with high-functioning ASD where there is less need for support.AIM To summarize the research findings on PD in adults with ASD and without intellectual disability,focusing on comorbidity and differential diagnosis.METHODS PubMed searches were performed using the key words“Asperger’s Syndrome”,“Autism”,“Personality”,“Personality disorder”and“comorbidity”in order to identify relevant articles published in English.Grey literature was identified through searching Google Scholar.The literature reviews and reference sections of selected papers were also examined for additional potential studies.The search was restricted to studies published up to April 2020.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria:16 evaluated personality profiles or PD in ASD(comorbidity),five compared ASD and PD(differential diagnosis)and one performed both tasks.There were significant differences in the methodological Cluster A and cluster C PD are the most frequent co-occurring PD,but overlapping features should be considered.Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists.Further studies are needed to explore the complex relationship between ASD and PD.
文摘Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.
文摘BACKGROUND The lack of space,as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms,remains controversial.AIM To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with autosomal dominant polycystic kidney disease.METHODS One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without(kidney transplant alone(KTA)group)and 77 with associated ipsilateral nephrectomy(KTIN group),were retrospectively reviewed.Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.RESULTS Creation of space for future graft positioning was the main reason(n=74,96.1%)for associated ipsilateral nephrectomy.No significant difference in surgical comorbidity(lymphocele,wound infection,incisional hernia,wound hematoma,urinary infection,need for blood transfusion,hospitalization stay,Dindo Clavien classification and readmission rate)was observed between the two study groups.The incidence of primary nonfunction and delayed graft function was comparable in both groups[0%and 2.6%(P=0.497)and 9.1%and 16.9%(P=0.230),respectively,in the KTA and KTIN group].The 1-and 5-year graft survival were 94.8%and 90.3%,and 100%and 93.8%,respectively,in the KTA and KTIN group(P=0.774).The 1-and 5-year patient survival were 96.1%and 92.9%,and 100%and 100%,respectively,in the KTA and KTIN group(P=0.168).CONCLUSION Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with autosomal dominant polycystic kidney disease does not negatively impact surgical comorbidity and short-and long-term graft survival.
基金Supported by A grant from the Danish Council for Independent Research under the Danish Agency for Science,Technology and Innovation No.10-081838/FSS
文摘Cirrhosis patients’comorbidities are their other diseases than cirrhosis.Comorbidities are neither causes nor consequences of cirrhosis,but they can increase mortality and are therefore clinically important.They are also an important source of confounding in epidemiologic studies.Comorbidity scoring systems have been developed as tools to measure the cirrhosis patient’s total burden of comorbidity,and they are useful in the clinic and for epidemiologic studies.The recently developed CirCom score is the only comorbidity scoring system developed specifically for cirrhosis patients,and it may be preferred over the older,generic,and more complex Charlson comorbidity index.Studies of individual comorbid diseases can provide insight into the interactions between cirrhosis and other diseases and thus into the pathophysiology of cirrhosis.This article reviews the literature on comorbidity in cirrhosis.
文摘BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,P<0.001;median 4(IQR 3-5)vs 5(IQR 4-6.5)d,P=0.005,respectively.Following multivariable analysis,the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function;in addition the dichotomous variables of age over75 years and ACCI more than 7 were significant predictors of hospital stay.No outcomes were significantly associated with Clavien-Dindo grading.Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS(median6-IQR 5-8-vs 7-IQR 6-12-d,P=0.013)and later TFF(median 2-IQR 1-3-vs 3-IQR 2-4-d,P=0.008),while patients with ACCI more than 7 were only associated with a prolonged hospital stay(median 7-IQR 5-8-vs 7-IQR 6-14.5-d,P=0.036).CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach,but older age and several comorbidities tend to reduce its benefits.
文摘Aim: The aim of this study was to investigate the impact of war on children and comorbidity of post traumatic stress disorder, attention deficit with hyperactivity, conduct, and oppositional defiant disorder in Palestinian children. Methods: The study was conducted in the entire Gaza Strip 6 months after the end of the war on Gaza that lasted for 23 days. The study sample included 410 children aged 6 to 17 years. Children completed measures of experience of traumatic events (Gaza Traumatic Checklist-War on Gaza), post traumatic stress disorder index, attention deficit with hyperactivity scale for parents and self, conduct disorder scale, and oppositional defiant disorder. Results: Palestinians children investigated 6 months after the war on Gaza still reported traumatic experiences: 94.6% heard the sonic sounds of the jet fighters, 91.7% heard shelling of the area by artillery, 92% watched mutilated bodies on television, 80% were deprived from water or electricity during the war, 50.7% said they left home for safer place. Using Diagnostic Manual of Mental Disorders-IV (DSM-IV) criteria for post traumatic stress disorder, 25.1% of children reported no psychological reactions, 25.9% of children reported one criteria, 39.3% of children reported partial post traumatic stress disorder and 9.8% of children reported full criteria for post traumatic stress disorder. According to the parents’ report, the results showed 31.3% of children met the criteria for inattentive type, 36.3% of children were impulsive and 29% met criteria for combined type. According to the children’s report, the results showed 28.8% of children met the criteria for inattentive type, 37.3% of children were impulsive and 28.3% met criteria for combined type. Using DSM-IV diagnostic criteria of conduct disorder and oppositional defiant disorder, the study showed that 38.1% of parents reported conduct disorder in their children and 46.3% reported oppositional defiant disorder. While 39.3% of children themselves reported conduct disorder and 44% of them reported oppositional defiant disorder. The study showed that 5.1% of children had comorbidity of post traumatic stress disorder and attention deficit disorder, 4.4% had comorbidity of post traumatic stress disorder and impulsivity-hyperactivity disorder, and 4.4% had comorbidity of post traumatic stress disorder and attention deficit with hyperactivity combined type. Also, 4.6% of children had comorbidity of conduct and post traumatic stress disorder and 6.1% had comorbidity of oppositional defiant disorder and post traumatic stress disorder. Conclusions: This study revealed that children living in areas of conflict and war are the main group at risk of developing post traumatic stress disorder and other behavioral problems including attention deficit with hyperactivity, conduct, and oppositional defiant disorder, and the internationallaws must protect the civilians during the conflict, establishing safe havens for children and their families to decrease the effect of war on children.
文摘Objective: To investigate the potential comorbidity biomarkers for Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s disease (AD). Methods: This is a randomized case-control study. There are three groups: 1) normal control group included 32 healthy elderly people in the hospital physical examination;2) 30 patients with T2DM group;and 3) AD group has 28 cases. On-line reversed-phase liquid chromatography separation, tandem mass spectrometry analysis and iTRAQ quantification were used for identification of peptidomic analysis, then detection of three comorbidity biomarkers might be associated with T2DM and AD by ELISA. Results: The Peptidomic Analysis of the potential comorbidity biomarkers for T2DM and the AD group includes Osteopontin (OPN), Isoform 2 of Histone H2Btype 2-F and Histone H4. These potential comorbidity biomarkers for T2DM and the AD group are significantly increased than normal control group. OPN concentrations are 1.67 (0.13 - 2.63) mmol/L in the normal control group, 3.15 (1.51 - 5.35) mmol/L in the T2DM group, and 7.66 (3.55 - 15.38) mmol/L in the AD group. Histone H4 concentrations in three groups respectively are 0.21 ± 0.036 mmol/L (normal control), 0.21 ± 0.046 mmol/L (T2DM) and 0.21 ± 0.034 mmol/L(AD). Isoforms 2 of Histone H2Btype 2-F are 1.73 (0.12 - 2.60) mmol/L, 4.71 (1.26 - 6.84) mmol/L and 9.30 (0 - 20.8) mmol/Lin three groups respectively. Conclusion: The inflammatory mechanism may lead to an increase of histone content in the urine of AD and T2DM patients. Clinical test of these potential comorbidity biomarkers Histones and Osteopontin would be the diagnosis of comorbidity AD and T2DM.
文摘Introduction: Abdominal deposition of fat has been described as the type of obesity that offers the greatest risk for the health of individuals, and is associated with increased mortality, and morbidity. Conicity index (Ci), Body mass index (BMI), and waist hip ratio (WHR) are used to predict the risk of obesity related diseases. However, it has not been ex amined whether these indicators can predict the comorbidities in hemodialysis subjects in Lebanon. Objective: to determine the effect of central obesity on comorbidities in hemodialysis patients in Lebanon. Material and Method: This is a cross-sectional study of obesity in 60 hemodialysis subjects in Lebanon. A linear regression analysis was used to determine the relationship between BMI, Ci, WHR, and comorbidities measured by Charlson (CCI) and Davies comorbidities indexes. Results: Ci values were significantly associated with age, and CCI;the abdominal fat deposition evaluated by the conicity index and WHR were a predictor of the comorbidities according to CCI (= 2.96;p = 0.01), and Davies comorbidity index (= 1.19;p = 0.05) scores. BMI was a weak predictor of comorbidity. Conclusion: Abdominal obesity by using simple anthropometric measurements e.g. Ci, and WHR values can similarly predict the presence of comorbidities in hemodialysis patients. Maintaining appropriate Ci and WHR values might be important to improve outcome in hemodialysis patients.
基金supported by the NHS National Specialised Commissioning Group/ NHS Englandsupported by the Faculty Scholarship from Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
文摘AIM To explore the effect of primary liver disease and comorbidities on transplant length of stay(TLOS) and LOS in later admissions in the first two years after liver transplantation(LLOS). METHODS A linked United Kingdom Liver Transplant Audit- Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in Englandwas analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS In 3772 patients, the mean(95%CI) TLOS was 24.8(24.2 to 25.5) d, and the mean LLOS was 24.2(22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group(6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group(14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d(5.7 to 11.3) longer TLOS and 6.0 d(0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS.CONCLUSION The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS.
文摘The prevalence of persons with social anxiety disorder (SAD) in Japan remains unknown. This study examined 293 patients with age between 20 and 60 at first visit on the outpatient clinic of psychiatry by the section of social phobia of M.I.N.I. and DSM-IV. After that, 10 patients with both SAD out of 16 patients (trial recruited) completed 12 weeks of treatment with paroxetine. Among 63 patients with 4 points and 40 patients with 3 points on the M.I.N.I., 21 patients (33%) and 16 patients (40%) were diagnosed as SAD on DSM-IV criteria, respectively. Together, 37 patients (12.6%) were diagnosed as SAD out of the 293 outpatients. Among 37 patients with SAD, 23 patients (62%) had comorbid depression. As for 10 patients after treatment with paroxetine, 8 patients improved from the point of recovery of depression (HAM-D scores below 10), whereas only 4 patients improved from the point of recovery of social phobia (L-SAS scores below 30). Three points as well as 4 points on the M.I.N.I. is meaningful for the diagnosis of SAD. For a while, paroxetine exerted less beneficial effects on SAD rather than on depression.
文摘The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Vergata University. 38 patients out of 86 (44.2%) presented one or more psychiatric comorbidities, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychotic symptoms. We compared our sample with the evidences from the scientific literature on psychiatric comorbidity in ASD patient, in particular in HFA/AS. In this paper we focus on the high frequency of comorbid psychiatric disorders in HFA/AS patients, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychosis, including schizophrenia. We analyzed rates of all psichiatric comorbidities diagnosed in a sample of HFA/AS subjects and we compared findings from our study with the evidences from the scientific literature on psychiatric comorbidity in ASD patients, in particular HFA/AS. We point out that comorbid psychiatric symptoms can be hardly diagnosed, because they could present atipically in ASDs then in general population. Furthermore, they could be masked by ASD core symptoms.
