Cardiac toxicity associated with dose and gender in patients undergoing chemoradiation for esophageal carcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 112-112 ◽  
Author(s):  
Lauren Marie Tait ◽  
Joshua E. Meyer ◽  
Erin McSpadden ◽  
Jonathan D. Cheng ◽  
Philip Agop Philip ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Esophageal Carcinoma ◽  
Cardiac Toxicity ◽  
Tumor Location ◽  
T Test ◽  
Heart Volume ◽  
Female Patients ◽  
Dose Volume ◽  
Increased Risk ◽  
Significant Difference

112 Background: The purpose of this study was to identify factors associated with symptomatic cardiac toxicity in patients treated with chemoradiotherapy (CRT) for esophageal carcinoma. Methods: One-hundred and forty-four patients with adenocarcinoma or squamous cell carcinoma were treated from 7/2002 - 6/2011 at 2 academic institutions with pre-operative, definitive or palliative CRT. Chemotherapy and radiation therapy was administered at the discretion of the treating oncologist. Altogether, 120 patients had sufficient dose volume histogram (DVH) data for analysis and ≥3 month follow up from treatment completion. Association of cardiac toxicity with a number of variables was investigated, including heart disease, cardiac bypass/angioplasty, diabetes, insulin use, smoking, and tumor location (upper/middle vs. lower/GE junction). T-test assessed risk of cardiac toxicity secondary to age. Percentage of heart volume receiving >20, 30, 40, and 50 Gy (V20-V50) and its association with cardiac toxicity was evaluated for each patient. Fisher’s exact test was used to test for an association between dose volume parameters and cardiac toxicity. Results: Patient population included 93 males and 27 females with a mean age of 63 years. Any cardiac toxicity occurred in 27 patients, 8 of which were symptomatic. T-test comparing age to toxicity was not significant; however, female patients were 3.57 times more likely to have cardiac toxicity ([95% Confidence Interval 1.42-9.01], p=0.005). A significant difference in V40 existed between patients with cardiac toxicity and those without (p=0.05). Patients above the median cut-off for V40 (54%) had 2.48 increased odds of developing cardiac toxicity ([95% Confidence Interval 1.02-6.02], p=0.04). None of the other investigated variables were associated with an increased risk of developing cardiac toxicity. Conclusions: Female patients were found to have an increased risk of cardiac toxicity subsequent to receiving CRT for esophageal carcinoma. V40 greater than 54% was associated with increased cardiac toxicity. These data suggest exercising increased care when designing radiation fields in women undergoing CRT for esophageal carcinoma.

scholarly journals Assessment of decrease in renal function associated with hypothyroidism

2021 ◽  
Vol 12 (1) ◽  
pp. 275-286
Author(s):  
Ayesha Ammar ◽  
Kahkashan Bashir Mir ◽  
Sadaf Batool ◽  
Noreen Marwat ◽  
Maryam Saeed ◽  
...  
Keyword(s):  
Renal Function ◽  
Confidence Interval ◽  
Creatinine Clearance ◽  
Confidence Intervals ◽  
Standard Error ◽  
Radioactive Iodine ◽  
T Test ◽  
Euthyroid State ◽  
Significant Difference ◽  
The Mean

Objective: Study was aimed to see the effects of hypothyroidism on GFR as a renal function. Material and methods: Total of Fifty-eight patients were included in the study. Out of those forty-eight patients were female and the rest were male. Out of fifty eight patients, fifty three patients were of thyroid cancer in which hypothyroidism was due to discontinuation of thyroxine before the administration of radioactive iodine for Differentiated thyroid cancer.Moreover, remaining five patients were post radioactive iodine treatment (for hyperthyroidism) hypothyroid. All of the patients were above eighteen years of age with TSH value > 30µIU/ml. Pregnant and lactating females were excluded.Renal function tests (urea/creatinine, creatinine clearance) and serum electrolytes followed by Tc-99m-DTPA renal scan for GFR assessment (GATES’ method) were carried out in all subjects twice during the study, One study during hypothyroid state (TSH > 30 µIU/ml) and other during euthyroid state (TSH between 0.4 to 4µ IU/ml). The results of Student’s t-test showed significant difference in renal functions (Urea, creatinine, creatinine clearance, GFR values) in euthyroid state and hypothyroid state (p-value <0.05). RESULTS: In case of creatinine the paired t test reveal the mean 1.014±0.428, with standard error of 0.669 within 95% confidence interval, for creatinine clearance 80.11±14.12 with standard error of 1.94 within 95% confidence intervals, for urea the mean 28±12.13 with standard error of 1.607 within 95% confidence intervals and for GFR for individual kidney is 38.056±8.56 with standard error of 1.3717 within 95% confidence interval. There was no difference in the outcome of the 2 groups. Conclusion: Hypothyroidism impairs renal function to a significant level and hence needs to be prevented and corrected as early as possible.

scholarly journals Potential Increased Risk of Trisomy 18 Observed After a Fertilizer Warehouse Fire in Brazos County and TX

2020 ◽  
Vol 17 (7) ◽  
pp. 2561
Author(s):  
Xiaohui Xu ◽  
Xiao Zhang ◽  
JeongWon Han ◽  
Yau Adamu ◽  
Bangning Zhang
Keyword(s):  
Observational Study ◽  
Confidence Interval ◽  
Trisomy 21 ◽  
Trisomy 18 ◽  
Chromosomal Anomalies ◽  
Live Births ◽  
Increased Risk ◽  
Significant Difference ◽  
Warehouse Fire ◽  
Fire Accident

Background: In this paper, we aimed to investigate the potential impacts of a fire accident in a fertilizer warehouse on chromosomal anomalies, including Trisomy 21 (T21) and Trisomy (T18) among pregnancies in Brazos County, Texas. We conducted an observational study in Brazos County, TX, with all patients of T18 and T21 cases in the live births in Brazos County between 2005–2014. The prevalence of T18 and T21 before, during, and after the accident in Brazos County were calculated and compared. The Standardized Morbidity Ratio (SMR) was applied to compare the prevalence of T18 and T21 in Brazos County to the statewide prevalence in Texas after adjusting for maternal race and age. Compared with statewide risk, the risk of T18 during the impacted years in Brazos county was found to be significantly higher (SMR = 5.0, 95% Confidence Interval(CI): 2.19–9.89), while there was no significant difference before (SMR = 0.77, 0.13–2.54) and after the accident (SMR = 0.71, 0.12–2.36). However, the prevalence of T21 during the impacted years was not significantly different from those before or after the accident. This study conclusively suggests that this fertilizer fire may be related to the increased prevalence of T18 in Brazos County, though the findings warrant further investigation.

Women at increased risk for cardiac toxicity following chemoradiation therapy for esophageal carcinoma

2013 ◽  
Vol 3 (4) ◽  
pp. e149-e155 ◽  
Author(s):  
Lauren M. Tait ◽  
Joshua E. Meyer ◽  
Erin McSpadden ◽  
Jonathan D. Cheng ◽  
Frank A. Baciewicz ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Cardiac Toxicity ◽  
Chemoradiation Therapy ◽  
Increased Risk

Abstract 190: Prediction of Intracranial Aneurysm Growth Based on Morphology

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Aichi Chien ◽  
Emiko Morimoto ◽  
Hajime Yokota ◽  
Pablo Villablanca ◽  
Noriko Salamon
Keyword(s):  
Intracranial Aneurysm ◽  
Surface Area ◽  
Morphological Characteristics ◽  
T Test ◽  
Maximum Diameter ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Aneurysm Growth

Introduction: Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. To plan more effective monitoring and intervention strategies, it would be beneficial to identify aneurysms which are likely to grow. Hypothesis: Morphological characteristics at initial diagnosis differ between unruptured intracranial aneurysms that will grow and those that are stable. Methods: A total of 58 cases of aneurysms in our medical center with follow-up imaging dates in 2015 were selected. All CTA images for the aneurysms were collected, for a total of 250 image sets. Aneurysm 3D geometry was reconstructed and morphological characteristics, including volume, surface area, and non-sphericity index (NSI) were calculated. NSI was calculated as 1 - (18π) 1/3 V 2/3 /S, where V and S represent aneurysm volume and surface area, respectively. Statistical comparisons were made using a two-tailed t-test with an assumption of unequal variance (Welch’s t-test). Results: Aneurysms were followed for an average of 50.5±50.9 months, with an average of 3.29±2.66 follow-up imaging dates. 9 aneurysms exhibited a size increase (>0.6mm) and the remaining 49 aneurysms did not. Based on their maximum diameter, no significant difference was found between initial aneurysm size between the growth (3.80±1.72 mm) and non-growth (4.26±2.00 mm) groups (p=0.13). Likewise, no significant differences in volume or surface area were found (p=0.33, p=0.36, respectively). However, initial NSI was found to be significantly higher in the growth (0.32±0.11) vs. the non-growth (0.23±0.08) group (p=0.049). Conclusions: Among aneurysms with similar size, NSI may be useful for identifying aneurysms which are more likely to grow and planning monitoring strategies accordingly. Higher initial NSI in the aneurysms which eventually grew is consistent with previous findings that higher NSI correlates with increased risk of rupture.

scholarly journals Current understanding of bleeding with ibrutinib use: a systematic review and meta-analysis

2017 ◽  
Vol 1 (12) ◽  
pp. 772-778 ◽  
Author(s):  
François Caron ◽  
Darryl P. Leong ◽  
Christopher Hillis ◽  
Graeme Fraser ◽  
Deborah Siegal
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Confidence Interval ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Allocation Concealment ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Significant Difference ◽  
Event Rates

Abstract Ibrutinib therapy was associated with an increased risk of bleeding in previous trials. In this systematic review and meta-analysis of published trials including patients treated with ibrutinib, the relative risk (95% confidence interval [CI]) of overall bleeding was significantly higher in ibrutinib recipients (2.72 [1.62-6.58]), but major bleeding did not show a significant difference (1.66 [0.96-2.85]). The incidences (95% CI) of major bleeding and any bleeding were 3.0 (2.3-3.7) and 20.8 (19.1-22.1) per 100 patient-years, respectively. This analysis is limited by reporting bias from variable ascertainment of bleeding and lack of allocation concealment in some studies and differing exposures between groups, leading to potential overestimation of event rates in the ibrutinib group.

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope(VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT.METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC).RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.03, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age may be a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

scholarly journals Monitoring the Absorption Dose of X-ray Radiation on the Thoracic Examination

2020 ◽  
Vol 21 (1) ◽  
pp. 8
Author(s):  
I Made Hendra Hadinata ◽  
Ni Nyoman Rupiasih
Keyword(s):  
Absorbed Dose ◽  
T Test ◽  
Electric Voltage ◽  
Male And Female ◽  
Significance Level ◽  
X Ray ◽  
Female Patients ◽  
Exposure Factor ◽  
Significant Difference ◽  
Factor Data

The study of monitoring the absorption dose of X-ray radiation received by thoracic examination patients has been conducted. The absorbance dose received by the patient is calculated from the exposure factor data consisting of electric voltage (kV), current (mA), time (s), and examination distance (m). Data were obtained from 130 male patients and 60 female patients, who performed thoracic examinations in a Posterior Anterior (PA) position. The absorbed dose received by male and female patients is compared with the maximum absorbed dose determined by BAPETEN for thoracic examinations on adult patients, which is 0.4 mGy. Differences in the absorbed dose received by male and female patients were identified by the T-test of two free samples with a significance level of 0.05. The results showed that the dose of X-ray radiation received by male and female patients was still below the maximum absorbed dose determined by BAPETEN, and the results of the T-test showed no significant difference in the absorbed dose received by male and female patients.

scholarly journals Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882297 ◽  
Author(s):  
Austin V. Stone ◽  
Avinesh Agarwalla ◽  
Anirudh K. Gowd ◽  
Cale A. Jacobs ◽  
Jeffrey A. Macalena ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Shoulder Surgery ◽  
Vascular Thrombosis ◽  
Oral Contraceptive Pills ◽  
Matched Group ◽  
Female Patients ◽  
Contraceptive Pills ◽  
Increased Risk ◽  
Significant Difference ◽  
Arthroscopic Shoulder Surgery

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P > .99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively ( P = .2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P = .2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P < .001) and obesity (OR, 1.43; P = .002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon’s standard prophylaxis protocol for arthroscopic shoulder surgery.

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope (VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT. METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Binary logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC). RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the binary logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.034, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05) . The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age was a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

Evaluating resident involvement and the ‘July effect’ in parotidectomy

2021 ◽  
pp. 1-6
Author(s):  
D A Benito ◽  
I Mamidi ◽  
L J Pasick ◽  
A D Sparks ◽  
C Badger ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Confidence Interval ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Improvement Program ◽  
Resident Participation ◽  
Increased Risk ◽  
Significant Difference ◽  
July Effect ◽  
Resident Involvement

Abstract Objective This study aimed to evaluate the effect of resident involvement and the ‘July effect’ on peri-operative complications after parotidectomy. Method The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. Results There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05–0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11–0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. Conclusion Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.

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