scholarly journals Irregularly shaped lacunar infarction: risk factors and clinical significance

2013 ◽  
Vol 71 (10) ◽  
pp. 769-773 ◽  
Author(s):  
Chao Feng ◽  
Yu Xu ◽  
Ting Hua ◽  
Xue-Yuan Liu ◽  
Min Fang
Keyword(s):  
Risk Factors ◽  
Clinical Significance ◽  
Blood Pressure Variability ◽  
Independent Risk Factor ◽  
Neurological Deterioration ◽  
Lacunar Infarct ◽  
Lacunar Infarction ◽  
Regular Group ◽  
Lacunar Infarcts ◽  
Independent Risk Factors

Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. The characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.

Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Tang ◽  
Y Yao ◽  
S.D Jia ◽  
Y Liu ◽  
B Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Coronary Intervention ◽  
Premature Coronary Artery Disease ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Cerebrovascular Events ◽  
Independent Risk Factors ◽  
Artery Disease

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P<0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P>0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P<0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P<0.001; HR=1.758, 95% CI: 1.365–2.264, P<0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China

scholarly journals Aneurysm characteristics and risk of rebleeding after subarachnoid haemorrhage

2018 ◽  
Vol 4 (2) ◽  
pp. 153-159
Author(s):  
Inez Koopman ◽  
Jacoba P Greving ◽  
Irene C van der Schaaf ◽  
Albert van der Zwan ◽  
Gabriel JE Rinkel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aspect Ratio ◽  
Subarachnoid Haemorrhage ◽  
Independent Risk Factor ◽  
Irregular Shape ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Size ◽  
Aneurysm Treatment ◽  
Independent Risk Factors

Introduction Knowledge of risk factors for rebleeding after aneurysmal subarachnoid haemorrhage can help tailoring ultra-early aneurysm treatment. Previous studies have identified aneurysm size and various patient-related risk factors for early (≤24 h) rebleeding, but it remains unknown if aneurysm configuration is also a risk factor. We investigated whether irregular shape, aspect- and bottleneck ratio of the aneurysm are independent risk factors for early rebleeding after aneurysmal subarachnoid haemorrhage. Patients and methods From a prospectively collected institutional database, we investigated data from consecutive aneurysmal subarachnoid haemorrhage patients who were admitted ≤24 h after onset between December 2009 and January 2015. The admission computed tomographic angiogram was used to assess aneurysm size and configuration. With Cox regression, we calculated stepwise-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for irregular shape, aspect ratio ≥1.6 mm and bottleneck ratio ≥1.6 mm. Results Of 409 included patients, 34 (8%) patients had in-hospital rebleeding ≤24 h after ictus. Irregular shape was an independent risk factor for rebleeding (HR: 3.9, 95% CI: 1.3–11.3) after adjustment for age, sex, PAASH score, aneurysm location, aneurysm size and aspect- and bottleneck ratio. Aspect ratio ≥1.6 mm (HR: 2.3, 95% CI: 0.8–6.5) and bottleneck ratio ≥1.6 mm (HR: 1.7, 95% CI: 0.8–3.6) were associated with an increased risk of rebleeding, but were not independent risk factors after multivariable adjustment. Conclusions Irregular shape is an independent risk factor for early rebleeding. However, since the majority of subarachnoid haemorrhage patients have an irregular aneurysm, additional risk factors have to be found for aneurysm treatment prioritisation.

scholarly journals Prognostic Factors of Colorectal Cancer: A Comparative Study on Patients With or Without Liver Metastasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Honghua Peng ◽  
Guifeng Liu ◽  
Ying Bao ◽  
Xi Zhang ◽  
Lehong Zhou ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Risk Factor ◽  
Liver Metastasis ◽  
Adjuvant Therapy ◽  
Independent Risk Factor ◽  
Stage Iv ◽  
Genetic Alterations ◽  
Stage Ii ◽  
Independent Risk Factors

BackgroundRadical or palliative surgery with subsequent adjuvant therapy is the routine treatment for stage II/III colorectal cancer(CRC) and some stage IV CRC patients. This study aimed to clarify the prognostic clinicopathological and genetic factors for these patients.MethodsFifty-five stage II-IV CRC patients undergoing surgery and adjuvant therapy were recruited, including patients without liver metastasis(5 at stage II, 21 at stage III) and with liver metastasis(29 at stage IV). Genetic alterations of the primary cancer tissues were investigated by whole exome sequencing(WES). Patients were followed up to 1652 days(median at 788 days).ResultsThe mutational landscape of primary CRC tissue of patients with or without liver metastasis was largely similar, although the mutational frequency of TRIM77 and TCF7L2 was significantly higher in patients with liver metastasis. Several main driver gene co-mutations, such as TP53-APC, APC-KRAS, APC-FRG1, and exclusive mutations, such as TP53-CREBBP, were found in patients with liver metastasis, but not in patients without liver metastasis. No significant difference was found between the two groups in aberrant pathways. If stage II-IV patients were studied altogether, relapse status, SUPT20HL1 mutations, Amp27_21q22.3 and Del8_10q23.2 were independent risk factors(P<0.05). If patients were divided into two groups by metastatic status, surgery types and Amp6_20q13.33 were independent risk factors for patients without liver metastasis(P<0.05), while TRIM77 mutations were the only independent risk factor for patients with liver metastasis(P<0.05).ConclusionsSurgery types and Amp6_20q13.33 were independent risk factors for CRC patients without liver metastasis, and TRIM77 mutations were the independent risk factor for CRC patients with liver metastasis.

scholarly journals What Are the Survival Factors in Surgically Resected Synchronous Multiple Primary Lung Cancers: A Retrospective Study

2020 ◽  
Author(s):  
Haichao Li ◽  
Kai Wang ◽  
Xingxing Zhang ◽  
Rong Chen ◽  
Jian Zhao
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Lymph Node ◽  
Independent Risk Factor ◽  
Complete Resection ◽  
Tnm Stage ◽  
Smoking History ◽  
Node Dissection ◽  
Multiple Primary ◽  
Independent Risk Factors

Abstract BackgroundWith the popularization of high-resolution computed tomography (HRCT), the detection rate of synchronous multiple primary lung cancer (SMPLC) is increasing. We retrospectively analyzed the surgical results of SMPLC patients in our hospital to determine the best treatment, surgical prognosis and survival analysis.MethodsA total of 78 SMPLC patients met the diagnostic criteria underwent complete resection and lymph node dissection or sampling without any preoperative induction therapy in the Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University. We analyzed the postoperative survival rate, and further studied the relationship between survival rates and sex, age, preoperative symptoms, tumor location, tumor number, tumor size, lymph node metastasis, TNM stage, surgical type, surgical frequency, histopathologic types, vascular infiltration, visceral pleural invasion and postoperative therapy.ResultsAmong 78 patients, the 1-,2-,3-,4- and 5-year disease free survival (DFS) rates were 93.42%, 86.84%, 77.78%, 62.96%, and 60.00%, respectively, while the 1-,2-,3-,4- and 5-year overall survival (OS) rates were 94.73%, 92.11%, 82.22%, 77.78%, and 65.00%, respectively. TNM stage of the largest tumor (II:HR=7.40,III:9.01,p=0.002) was an independent risk factor for DFS. Smoking history (HR=4.34,p=0.039) and TNM stage of the largest tumor (II:HR=9.38,III:9.42,p=0.003) were independent risk factors for overall survival.ConclusionsFirst, SMPLC is different from intrapulmonary metastasis and its clinical stage is also different from the 8th (2015) edition TNM classification for lung cancer. Second, when pulmonary function permits, surgery (complete resection and lymph node dissection) is a significantly beneficial treatment for patients with SMPLC. Third, TNM stage of the largest tumor (II:HR=7.40,III:9.01,p=0.002) was an independent risk factor for DFS. Smoking history (HR=4.34,p=0.039) and TNM stage of the largest tumor (II:HR=9.38,III:9.42,p=0.003) were independent risk factors for overall survival.

Abstract 456: Increasing the Compression Velocity and Acceleration Improved the Quality of Simulated Chest Compression Under the Direction of Real Time Visual Feedback Device

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Yu Cao ◽  
Yarong He ◽  
Peng Yao
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Linear Regression ◽  
Real Time ◽  
Visual Feedback ◽  
Chest Compression ◽  
Independent Risk Factor ◽  
Baseline Test ◽  
Independent Risk Factors

Background: To investigate whether a real-time visual feedback device could improve the quality of chest compression (CC), and, if so, whether the mechanism is associated with dynamic indexes such as velocity and acceleration. Methods: A self-control trial of 2-minutes CC on a manikin by trained rescuers compared the quality of CC without or with a visual feedback device. Demographic characteristics were recorded and CC metrics for the two tests were computed. Multivariable linear regression analyses were performed to examine the impact of variables on rate of qualified chest compression (RQCC). Multivariable logistic regression was performed to determine independent risk factors for achieving qualified chest compression (QCC) in the second test. Results: A total of 159 participants (average age: 29.36±9.0 years, 80 (50.3%) men) were recruited. RQCC of the second test was significantly greater than that of the baseline test. Multivariable linear regression analysis showed that maximum compression velocity (V compression ) and maximum compression velocity (a compression ) were independent risk factors for RQCC for both tests. The mean V compression and a compression of the second test were significantly greater than those of the baseline test. However, V compression was the only independent risk factor predicting QCC achievement during the second test. ROC curve analysis showed the area under curve (AUC) was0.84,and the optimal cut-offvalue ofV compression was 39.48 cm/s. Conclusions: Increasing the V compression and a compression might improve the quality of simulated CC and should be recommended to improve QCC. Only V compression was an independent risk factor for achieving QCC during CC with a visual feedback device.

Blood Transfusion is Associated with Infection and Increased Resource Utilization in Combat Casualties

2006 ◽  
Vol 72 (7) ◽  
pp. 619-626 ◽  
Author(s):  
James R. Dunne ◽  
Mark S Riddle ◽  
Janine Danko ◽  
Rich Hayden ◽  
Kyle Petersen
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Blood Transfusion ◽  
Resource Utilization ◽  
Independent Risk Factor ◽  
Study Cohort ◽  
Icu Admission ◽  
Independent Risk Factors ◽  
Combat Casualties ◽  
Injured Patients

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 ± 2 years, a mean ISS of 14 ± 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 ± 4 vs. 10 ± 3, P < 0.01), a higher pulse rate (105 ± 4 vs. 93 ± 3, P < 0.0001), and a lower admission HCT (27 ± 1 vs. 33 ± 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 ± 2.1 days vs. 1.4 ± 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

scholarly journals The Impact of Graft Nephrectomy on Subsequent Transplants: Multivariate Analysis of Risk Factors for Second Graft Loss and for Multiple Transplantations–A Single-Center Retrospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanouil Giorgakis ◽  
Asim Syed ◽  
Hector Gonzalez
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Retrospective Study ◽  
Independent Risk Factor ◽  
Graft Loss ◽  
Kaplan Meier ◽  
Independent Risk Factors ◽  
Allograft Loss ◽  
The Impact

Introduction. The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting. Aim of this study is to review the impact of failed primary graft nephrectomy on future transplants. Materials/Methods. Retrospective study of 101 patients retransplanted in a single institution. Median follow-up was 68 months. Patients were divided into two groups; G1 (n=49) was the nephrectomy group; G2 (n=52) was the graft in situ group. The patients’ and second graft survival were analysed with the Kaplan-Meier method. The patients’ and transplant characteristics were analyzed with student’s t-test. The retransplant risk factors and the risk factors for multiple transplants were obtained via a logistic regression model. Results. The odds of second graft loss post-transplantectomy were high (OR = 5.24). Demographics, HLA mismatch and first graft rejection rates were similar among the two groups and did not affect the outcome. Transplantectomy accelerated the loss of a future failing graft. Multivariate analysis showed transplantectomy as independent risk factor for second allograft loss. Transplantectomy and younger age are significant independent risk factors for future multiple transplants. Conclusion. Transplantectomy of the failed primary graft is an independent risk factor for retransplant loss and for multiple renal transplants.

scholarly journals The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study

2018 ◽  
Vol 33 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Wataru Takayama ◽  
Hazuki Koguchi ◽  
Akira Endo ◽  
Yasuhiro Otomo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Independent Risk Factor ◽  
Retrospective Observational Study ◽  
Multivariate Logistic Regression ◽  
Chest Injuries ◽  
Independent Risk Factors

AbstractObjectivesThe aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA).MethodsThis retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed.ResultsA total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant.ConclusionsLong duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times.TakayamaW, KoguchiH, EndoA, OtomoY. The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171–175.

scholarly journals Risk factors of recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism: from the COMMAND VTE Registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Yamashita ◽  
H Amano ◽  
T Morimoto ◽  
T Kimura ◽  
Keyword(s):  
Risk Factors ◽  
Major Bleeding ◽  
Independent Risk Factor ◽  
Anticoagulation Therapy ◽  
Intermediate Risk ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Recurrent Vte

Abstract Background/Introduction Patients with venous thromboembolism (VTE), including pulmonary embolism (PE), have a long-term risk of recurrence, and anticoagulation therapy is recommended for the prevention of recurrence. The latest 2019 European Society of Cardiology (ESC) guideline classified the risks of recurrence into low- (&lt;3%/year), intermediate- (3–8%/year), and high- (&gt;8%/year) risk, and recommended the extended anticoagulation therapy of indefinite duration for high-risk patients as well as intermediate-risk patients. However, extended anticoagulation therapy of indefinite duration for all of intermediate-risk patients have been a matter of active debate. Thus, additional risk assessment of recurrence in intermediate-risk patients might be clinically relevant in defining the optimal duration of anticoagulation therapy. Furthermore, bleeding risk during anticoagulation therapy should also be taken into consideration for optimal duration of anticoagulation therapy. However, there are limited data assessing the risk of recurrence as well as bleeding in patients with intermediate-risk for recurrence based on the classification in the latest 2019 ESC guideline. Purpose The current study aimed to identify the risk factors of recurrence as well as major bleeding in patients with intermediate-risk for recurrence, using a large observational database of VTE patients in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. Results In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37). Conclusions Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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