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1
Deng, Lucy. "Seizures following vaccination: risk, outcome and recurrence." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/27195.
Повний текст джерелаАнотація:
Background
An adverse event following immunisation is any untoward medical occurrence that follows
immunisation and does not necessarily have a causal relationship with the usage of the vaccine.
Seizures, ranging from the common and mostly benign febrile seizure to the life-threatening status
epilepticus, that occur following immunisation are considered adverse events following immunisation.
Febrile seizures have been observed to occur in defined periods following vaccination when a fever is
most likely to occur. The magnitude of risk attributed to specific vaccines varies, with no known
increased risk seen for some vaccines. Status epilepticus, continuous seizure activity for 5 minutes or
more without return of consciousness, or recurrent seizure activity without a return to baseline
consciousness in between, has also been reported following vaccination, though the magnitude of
attributable risk is unclear. Both seizure types are rare, but serious adverse events, that can follow
and sometimes be triggered by immunisation. Because of the potential risk of neurodevelopmental
sequalae, seizures can affect both provider and consumer confidence in vaccine safety and therefore
immunisation coverage.
Knowledge gaps on seizures following vaccination include their clinical severity, developmental
outcomes, genetic risks and revaccination outcomes. In my thesis, I aimed to address these gaps to
better inform immunisation providers about the risks and outcomes of these potentially serious
adverse events following immunisation, to improve guidance on their assessment and management,
and ultimately to improve parent and consumer confidence in vaccine safety.
Febrile seizures following vaccination
In this thesis, I set out to assess the clinical severity, neurodevelopmental outcome and genetic risk of
febrile seizures following vaccination, to supplement the known attributable risk of febrile seizures
following specific vaccines. Vaccine proximate seizures were defined as VPS was defined as a
seizure within 14 days of a vaccination encounter, based on previous studies on the timing of fever
and febrile seizures following specific vaccines. I examined the clinical severity of vaccine-proximate febrile seizures through a multi-site prospective cohort study. I discovered that febrile seizures most
commonly occurred following the first dose of measles-containing vaccine, and were not clinically any
different to febrile seizures due to another cause such as a viral illness. The only factor that prolonged
hospitalisation in children with a vaccine-proximate febrile seizure was the presence of concomitant
laboratory-confirmed infection. A subsequent prospective case-control study was conducted to assess
developmental and behavioural outcomes, and to identify the presence of genetic variants in children
with vaccine-proximate febrile seizures compared to children with non-vaccine-proximate febrile
seizures and no history of seizures. Using standardised developmental tests administered by certified
assessors blinded to the child’s medical history and standardised parent-completed questionnaires,
this study found no increased risk of developmental or behavioural problems in children with vaccineproximate
febrile seizures compared to children with non-vaccine-proximate seizures or no history of
seizures. Genetic variants in the sodium channel gene, SCN1A, associated with a severe form of
epilepsy were only identified in children with prolonged vaccine-proximate febrile seizures.
Status epilepticus following vaccination
Prior to this thesis, there were only case reports and case series on vaccine-proximate status
epilepticus, presenting an incomplete and potentially biased picture of the risk and severity of vaccineproximate
status epilepticus that may not be generalisable to the whole population. Using a
retrospective, population-based, record-linked cohort linking birth, immunisation, hospitalisation and
death data, I was able to determine that less than 4% of first episode status epilepticus in children
was vaccine proximate. Similar to vaccine-proximate febrile seizures, status epilepticus was found to
occur most commonly following the first dose of measles-containing vaccine, but at a rate 35 times
lower than that of vaccine-proximate febrile seizure for the same risk window. There was no difference
in clinical severity, measured by duration of hospitalisation, intensive care unit admission or death,
between vaccine-proximate and non-vaccine-proximate status epilepticus cases. The predictor for
ongoing seizures subsequent to the first status epilepticus was seizure onset prior to the status
epilepticus episode. Importantly, vaccination uptake decreased following status epilepticus,
regardless of the proximity of the status epilepticus episode to vaccination. These findings were
confirmed in a second retrospective cohort study I conducted using medical record review to validate
the findings from the larger population-based retrospective study that relied on hospital administrative data. The retrospective cohort study also found morbidity following vaccine-proximate status
epilepticus was associated with the presence of an underlying genetic epilepsy, where the seizures
are the result of a known or presumed genetic defect.
Revaccination outcomes following vaccine-proximate seizures
Following the identification of the risk and outcome of seizures following vaccination, the next logical
clinical question to address was can these children safely proceed with subsequent vaccinations and,
if so, how? I, therefore, examined the risk of seizure recurrence following revaccination in children
with a previous vaccine-proximate seizure. Through a 5-year multi-site retrospective cohort study, I
reviewed the clinical management and outcomes of children with a history of vaccine-proximate
seizures who presented to a Specialist Immunisation Clinic, a specialist clinic at tertiary paediatric
hospitals where children with a vaccine proximate seizure are provided specialised medical
assessment and management for subsequent vaccinations. Vaccine-proximate seizure recurrence
was found to be more likely in children with an underlying genetic epilepsy, in particular Dravet
syndrome. Reassuringly, the risk of seizure recurrence decreased with the use of prophylactic
benzodiazepine with vaccination in these children.
Conclusions
Vaccination is one of the most effective public health measures for reducing the burden of infectious
diseases. However, the success of vaccination programs has been threatened by vaccine hesitancy,
that is, the reluctance or refusal to vaccinate despite vaccine availability. Concerns regarding the
safety of vaccines and their potential long-term neurological sequalae are amongst the complex
reasons why people choose not to vaccinate.
My doctoral research has contributed to vaccine safety knowledge globally, specifically in the
understanding of seizures, specifically febrile seizures and status epilepticus, as severe acute
neurological events following vaccination. In this thesis, I not only identified the children most at risk of
neurological sequelae following a vaccine-proximate seizure, but also a revaccination management
plan that would allow these children to continue vaccinations without placing them at risk of further vaccine-proximate seizures. These are children aged <12 months, whose underlying genetic epileptic
encephalopathy is unmasked by a vaccination event. These children typically present with status
epilepticus following vaccination, and are most likely to have further seizures with revaccination if it is
given without additional precautions in the form of prophylactic benzodiazepine. My thesis finding
highlights the importance of, and future work required to better understand, adversomics – the
immunogenetics and immunogenomics of vaccine adverse events at the individual and population
level, respectively – and its implications on vaccine safety, confidence and uptake.
Finally, my thesis incorporates a variety of research methods, from retrospective record-linked cohort
studies to examine whole-of-population risk, retrospective multi-site clinic-based cohort studies to
examine detailed clinical management and outcomes, and prospective case-control studies to test
hypotheses. I have demonstrated the unique contribution of each of these research methods and the
strength in combining these to form a broader pharmacovigilance program of research that can help
inform both risk and outcome at a population and individual level. By applying the doctoral research
skills I have acquired, I aim to continue my work as a vaccine safety clinician researcher in the
monitoring and investigation of vaccine safety signals for novel vaccines, including the multiple
COVID-19 vaccines currently in early use globally, to ensure the continued safe and effective use of
vaccines in the years to come.
2
Costa, Paulo Everton Garcia. "Risk factors for hepatocellular carcinoma recurrence after liver transplantation." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=11640.
Повний текст джерелаАнотація:
Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, with annual
worldwide incidence of over one million cases, accounting for at least 500,000 deaths per
year. The majority of cases of HCC occur in the setting of liver cirrhosis. Liver
transplantation (LT) is a curative treatment modality for HCC. However the recurrence of
HCC after LT is the main obstacle to the success of this treatment. The aim of this study was
to evaluate the risk factors for recurrence of hepatocellular carcinoma after conducting LT. In
this retrospective, descriptive and analytical study, between May 2002 and April 2012, were
conducted 664 liver transplantations (LT) at HUWC â UFC, among which 140 LT were
performed in patients with HCC. The risk factors of HCC recurrence after liver
transplantation were analysed. The variables analyzed were: sex, age, blood type, etiology of
cirrhosis, alpha-fetoprotein level, diagnostic imaging, Milan criteria, time from diagnosis of
HCC and the realization of LT, time on the waiting list for the LT and pathological tumor
characteristics in explant. The tumor was more frequent in men with an average age of 56
years, infected with hepatitis C virus. The rate of HCC recurrence after LT was 8, 57 % and
occurred more often in the first two years after transplantation, with the liver graft being the
most common site. In conclusion, independent risk factors for carcinoma hepatocellular
recurrence after liver transplantation were: time in the LT waiting list above 7,8 months, liver
number nodules over 3.5 nodules, tumors exceeding the Milan criteria, level of alphafetoprotein
above 1000 ng/ml and presence of micro-vascular invasion.O carcinoma hepatocelular (CHC) à o mais frequente tumor primÃrio maligno do fÃgado, com incidÃncia mundial anual de mais de um milhÃo de casos, sendo responsÃvel por pelo menos 500.000 mortes por ano. Em torno de 90 % a 95 % dos tumores estÃo associados à cirrose. O transplante hepÃtico (TH) à uma modalidade de tratamento curativo para o CHC. Entretanto, a recorrÃncia do CHC apÃs o TH à o principal obstÃculo ao sucesso deste tratamento. O objetivo deste estudo foi avaliar os fatores de risco para recorrÃncia de carcinoma hepatocelular apÃs a realizaÃÃo de TH. Foram realizados 664 transplantes de fÃgado entre maio de 2002 e abril de 2012, no Hospital UniversitÃrio Walter CantÃdio, da Universidade Federal do Cearà (HUWC â UFC), dos quais 140 casos em pacientes com diagnÃstico de CHC. Foi realizado um estudo analÃtico, descritivo, retrospectivo e longitudinal deste grupo de pacientes, analisando os fatores de risco para a recorrÃncia de CHC apÃs o TH. As variÃveis analisadas foram: sexo, idade, tipo sanguÃneo, etiologia da cirrose, nÃvel de alfa-fetoproteÃna, mÃtodos diagnÃsticos de imagem, critÃrios de MilÃo, tempo entre o diagnÃstico do CHC e a realizaÃÃo do TH, tempo em lista de espera para o TH e caracterÃsticas anatomopatolÃgicas do tumor no explante. O CHC foi mais frequente em homens com idade mÃdia de 56 anos, infectados pelo vÃrus da hepatite C. A taxa de recorrÃncia do carcinoma hepatocelular apÃs o transplante de fÃgado foi de 8,57% e ocorreu mais frequentemente nos dois primeiros anos apÃs o transplante, tendo como local mais comum o enxerto hepÃtico. Concluiu-se que o tempo de permanÃncia em lista de transplante acima de 7,8 meses, a presenÃa de mais de 3,5 nÃdulos no explante, o tumor excedendo os critÃrios de MilÃo, o nÃvel de Alfa-fetoproteÃna acima de 1000 ng/ml e a presenÃa de invasÃo microvascular sÃo fatores de risco independentes para recorrÃncia de carcinoma hepatocelular apÃs a realizaÃÃo do transplante hepÃtico.
3
Knut, R. P. "Groin hernia: anatomically determined risk factors for the recurrence." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19674.
Повний текст джерела
4
Stewart, Ann Mary. "Investigation of predictors of recurrent venous leg ulcers and validation of a recurrence risk assessment tool." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/133948/1/Ann_Stewart_Thesis_Redacted.pdf.
Повний текст джерелаАнотація:
Recurring venous leg ulcers are a serious health problem and it is difficult to predict when they are likely to recur. This research discovered new predictors of recurrence and found a checklist developed to assist in identifying the person's level of risk of recurrence, to be accurate more than 70% of the time. Prevention of recurrence is important and knowledge about the likelihood of these ulcers recurring can assist in preventing this from happening. This research has contributed knowledge to a topic which has had little previous research and has provided evidence to be further examined in large studies.
5
Liu, Lin, Karen Messer, John A. Baron, David A. Lieberman, Elizabeth T. Jacobs, Amanda J. Cross, Gwen Murphy, Maria Elena Martinez, and Samir Gupta. "A prognostic model for advanced colorectal neoplasia recurrence." SPRINGER, 2016. http://hdl.handle.net/10150/621531.
Повний текст джерелаАнотація:
Following colonoscopic polypectomy, US Multisociety Task Force (USMSTF) guidelines stratify patients based on risk of subsequent advanced neoplasia (AN) using number, size, and histology of resected polyps, but have only moderate sensitivity and specificity. We hypothesized that a state-of-the-art statistical prediction model might improve identification of patients at high risk of future AN and address these challenges. Data were pooled from seven prospective studies which had follow-up ascertainment of metachronous AN within 3-5 years of baseline polypectomy (combined n = 8,228). Pooled data were randomly split into training (n = 5,483) and validation (n = 2,745) sets. A prognostic model was developed using best practices. Two risk cut-points were identified in the training data which achieved a 10 percentage point improvement in sensitivity and specificity, respectively, over current USMSTF guidelines. Clinical benefit of USMSTF versus model-based risk stratification was then estimated using validation data. The final model included polyp location, prior polyp history, patient age, and number, size and histology of resected polyps. The first risk cut-point improved sensitivity but with loss of specificity. The second risk cut-point improved specificity without loss of sensitivity (specificity 46.2 % model vs. 42.1 % guidelines, p < 0.001; sensitivity 75.8 % model vs. 74.0 % guidelines, p = 0.64). Estimated AUC was 65 % (95 % CI: 62-69 %). This model-based approach allows flexibility in trading sensitivity and specificity, which can optimize colonoscopy over- versus underuse rates. Only modest improvements in prognostic power are possible using currently available clinical data. Research considering additional factors such as adenoma detection rate for risk prediction appears warranted.
6
Dalberg, Kristina. "Risk factors for ipsilateral breast tumor recurrence and uncontrolled local disease /." Stockholm, 1998. http://diss.kib.ki.se/search/diss.se.cfm?19981016dalb.
Повний текст джерела
7
Habel, Laurel A. "Risk of recurrence following ductal carcinoma in situ of the breast /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10931.
Повний текст джерела
8
Hu, Xinhai [Verfasser]. "Risk prediction models for biochemical recurrence after radical prostatectomy / Xinhai Hu." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2017. http://d-nb.info/114842539X/34.
Повний текст джерела
9
Froneberg, Eva. "Youth Cohorts and the Risk of Conflict Recurrence: A Global Quantitative Analysis." Thesis, Uppsala universitet, Institutionen för freds- och konfliktforskning, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-384563.
Повний текст джерелаАнотація:
While the role of youth in post-conflict settings has increasingly gained policy attention, systematic academic studies on this topic remain scarce. This research adds to existing literature by the youth bulge theory of conflict onset to a post-conflict setting. It hypothesizes that large youth bulges at the time conflict episodes end increase the feasibility for rebel groups to relaunch their insurgence and are therefore associated with a higher risk of conflict recurrence. A global quantitative analysis revealed a statistically significant positive correlation between youth bulges and conflict recurrence. Three conditional hypotheses which focus on elements of economic, political and social exclusion that are argued to interact with youth bulges to influence the risk of conflict recurrence found no empirical support. However, the combination of findings for Hypothesis 1 and non-findings for Hypotheses 2 may indicate that the underlying cause for the relationship between youth bulges and conflict recurrence may not be based on young people’s individual grievances and motives to join a rebel group. Instead, other factors may be at play which could not be tested within the scope of this study. Despite its shortcomings, this study therefore confirms the necessity of continuing to investigate the relationship between the age distribution of a population and the risk of conflict recurrence.
10
West, Emily S. "Risk factors for trichiasis recurrence in a trachoma-endemic area of central Tanzania." Available to US Hopkins community, 2002. http://wwwlib.umi.com/dissertations/dlnow/3068228.
Повний текст джерела
11
Fertsch, Sonia Maria [Verfasser], and Christoph [Akademischer Betreuer] Andree. "Cancer recurrence risk after lipofilling in breast cancer patients with DIEP flap reconstruction." Freiburg : Universität, 2016. http://d-nb.info/1122743343/34.
Повний текст джерела
12
Deshpande, Abhishek, Vinay Pasupuleti, Priyaleela Thota, Chaitanya Pant, David D. K. Rolston, Adrian V. Hernandez, Curtis J. Donskey, and Thomas G. Fraser. "Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis." Cambridge University Press, 2015. http://hdl.handle.net/10757/608263.
Повний текст джерелаАнотація:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.OBJECTIVE: An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI. DESIGN: We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated. RESULTS: A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001). CONCLUSIONS: Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.
13
Corda, Gabriele. "Frizzled receptor 6 and risk of metastatic recurrence in early triple negative breast cancer." Thesis, Brunel University, 2015. http://bura.brunel.ac.uk/handle/2438/13098.
Повний текст джерелаАнотація:
WNT lipoglycoproteins (WNTs) modulate a plethora of cellular functions through the activation of the family of frizzled receptors (FZDs). Deregulation in components of the WNT signalling pathways is often observed in human cancers and associated with uncontrolled proliferation and metastasis. Frizzled receptor 6 (Fzd6), one of the ten human FZDs, is frequently overexpressed in cancer, but its role in tumorigenesis is still unclear. In this study we investigated the role Fzd6 in breast cancer. We found that expression of Fzd6 predicts distant relapse in patients with localised breast cancers, particularly in those bearing the triple negative subtype. Using a loss of function approach, we demonstrated that Fzd6 is important to regulate motility and invasion of breast cancer cells in vitro and in vivo. Indeed, Fzd6 regulates the tropism of breast cancer cells the bone, liver and heart of mice. Mechanistically, we found that Fzd6 signalling activates the small GTPase Rho and is important in the organisation of the fibronectin matrix. Both Rho and fibronectin have been previously implicated in the development of metastasis in different systems. All together, these results demonstrate that Fzd6 is an important driver of metastatic spread and a predictive marker of metastatic relapse in breast cancer patients. Fzd6 could therefore be used as a biomarker and target in metastatic breast cancer.
14
Acra, Erin E. "Estimating the Familial Recurrence Risk of Anorectal Malformation with Rectoperineal Fistula or Rectovestibular Fistula." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1218480164.
Повний текст джерела
15
Velentgas, Priscilla T. "Risk of recurrence and death following breast cancer : influence of pregnancy and hormone replacement therapy /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10865.
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16
Pennlert, Johanna. "Recurrent stroke : risk factors, predictors and prognosis." Doctoral thesis, Umeå universitet, Medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-127304.
Повний текст джерелаАнотація:
Background Many risk factors for stroke are well characterized and might, at least to some extent, be similar for first-ever stroke and for recurrent stroke events. However, previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. Patients who survive spontaneous intracerebral hemorrhage (ICH) often have compelling indications for antithrombotic (AT) treatment (antiplatelet (AP) and/or anticoagulant (AC) treatment), but due to controversy of the decision to treat, a large proportion of these patients are untreated. In the absence of evidence from randomized controlled trials (RCTs), there is need for more high- quality observational data on the clinical impact of, and optimal timing of AT in ICH survivors. The aims of this thesis were to assess time trends in stroke recurrence, to determine the factors associated with an increased risk of stroke recurrence – including socioeconomic factors – and to determine to what extent ICH survivors with and without atrial fibrillation (AF) receive AT treatment and to determine the optimal timing (if any) of such treatment. Methods The population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence register was used to assess the epidemiology and predictors of stroke recurrence after ischemic stroke (IS) and ICH from 1995 to 2008 in northern Sweden. Riksstroke, the Swedish stroke register, linked with the National Patient Register and the Swedish Dispensed Drug Register, made it possible to identify survivors of first-ever ICH from 2005 to 2012 with and without concomitant AF to investigate to what extent these patients were prescribed AP and AC therapy. The optimal timing of initiating treatment following ICH in patients with AF 2005–2012 was described through separate cumulative incidence functions for severe thrombotic and hemorrhagic events and for the combined endpoint “vascular death or non-fatal stroke”. Riksstroke data on first-ever stroke patients from 2001 to 2012 was linked to the Longitudinal Integration Database for Health Insurance and Labour market studies to add information on education and income to investigate the relationship between socioeconomic status and risk of recurrence. Results Comparison between the cohorts of 1995–1998 and 2004–2008 showed declining risk of stroke recurrence (hazard ratio: 0.64, 95% confidence interval (CI): 0.52-0.78) in northern Sweden. Significant factors associated with an increased risk of stroke recurrence were age and diabetes. Following ICH, a majority (62%) of recurrent stroke events were ischemic. The nationwide Riksstroke study confirmed the declining incidence, and it further concluded that low income, primary school as highest attained level of education, and living alone were associated with a higher risk of recurrence beyond the acute phase. The inverse effects of socioeconomic status on risk of recurrence did not differ between men and women and persisted over the study period. Of Swedish ICH-survivors with AF, 8.5% were prescribed AC and 36.6% AP treatment, within 6 months of ICH. In patients with AF, predictors of AC treatment were less severe ICH, younger age, previous anticoagulation, valvular disease and previous IS. High CHA2DS2-VASc scores did not seem to correlate with AC treatment. We observed both an increasing proportion of AC treatment at time of the initial ICH (8.1% in 2006 compared with 14.6% in 2012) and a secular trend of increasing AC use one year after discharge (8.3% in 2006 versus 17.2% in 2011) (p<0.001 assuming linear trends). In patients with high cardiovascular event risk, AC treatment was associated with a reduced risk of vascular death and non-fatal stroke with no significantly increased risk of severe hemorrhage. The benefit appeared to be greatest when treatment was started 7–8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within three years was 17.0% when AC treatment was initiated eight weeks after ICH and 28.6% without any antithrombotic treatment (95% CI for difference: 1.4% to 21.8%). For high-risk men, the corresponding risks were 14.3% vs. 23.6% (95% CI for difference: 0.4% to 18.2%). Conclusion Stroke recurrence is declining in Sweden, but it is still common among stroke survivors and has a severe impact on patient morbidity and mortality. Age, diabetes and low socioeconomic status are predictors of stroke recurrence. Regarding ICH survivors with concomitant AF, physicians face the clinical dilemma of balancing the risks of thrombosis and bleeding. In awaiting evidence from RCTs, our results show that AC treatment in ICH survivors with AF was initiated more frequently over the study period, which seems beneficial, particularly in high-risk patients. The optimal timing of anticoagulation following ICH in AF patients seems to be around 7–8 weeks following the hemorrhage.
17
Abraham, Elizabeth C. M. D. "Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013.
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18
DeFeo, Graig Charles. "Risk Factors for Recurrent Major Depressive Disorder in a Nationally Representative Sample." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5351.
Повний текст джерелаАнотація:
The public use version of the National Comorbidity Survey - Replication (NCS-R) dataset was used (N = 995) to investigate risk factors for recurrent major depressive disorder (MDD) that are evident before recovery from the first major depressive episode (MDE) by comparing persons diagnosed with MDD who experienced a single MDE to persons with recurrent MDD.
Multiple logistic regression analyses assessed the independent risk of recurrent MDD for each of the following risk factors: an early age of onset (old), absence of a life stress trigger, chronic first episode, childhood parental loss, parental maltreatment, parental depression, comorbid anxiety disorder, and comorbid substance disorder. The relative excess risk due to interaction (RERI) assessed the risk of recurrent MDD associated with the interaction of an early onset with three childhood-based vulnerabilities: a) parental depression, b) parental loss, and c) parental maltreatment.
There was a statistically significant risk of recurrent MDD found for the following risk factors: early onset, stress trigger absent, childhood parental loss, parental maltreatment, parental depression, and anxiety disorder; marginally significant results suggested an increased risk of recurrent MDD for substance disorder. There was a significant increased risk found for the interaction of an early onset with parental depression and similar non-significant trends were found for the interactions of early onset with parental loss and early onset with parental maltreatment.
An early onset, the absence of a life stress trigger, and the presence of parental loss, parental maltreatment, parental depression, a comorbid anxiety disorder, and a comorbid substance disorder each confer greater risk of recurrent MDD among persons that have not yet recovered from their first lifetime MDE. The presence of an early onset combined with a childhood-based vulnerability such as parental depression, parental loss, or parental maltreatment, indicate an especially high risk of recurrent MDD. These findings may inform the development of a screening tool to assess risk for recurrent MDD and early intervention to prevent recurrent MDD. Future research should employ a longitudinal research design to replicate and expand upon these findings.
19
Leong, Kai Juen. "Development of epigenetic-based prognostic biomarkers to stratify risk of recurrence in early rectal cancer." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4680/.
Повний текст джерелаАнотація:
Organ-preservation surgery for early rectal cancer is an alternative treatment to conventional radical surgery that offers comparable oncological outcome but has lower morbidity and mortality. The efficacy of this strategy relies on accurate preoperative staging of mesorectal nodal metastasis which current staging modalities are unable to deliver. DNA methylation has a prognostic role in colorectal carcinogenesis and may select for tumours suitable for local excision, although this has not been explored in rectal cancer. A panel of staged rectal cancers was analysed for differential DNA methylation patterns. This identified a unique signature consisting of concomitant hypermethylation of three or more of APC, RARB, GSTP1, TIMP3, CASP8, DAPK1 and CXCL12 that was associated with histopathologically localised disease. Correlation of protein expression with clinicopathological features found UNC5C expression to be associated with nodal status. Genome-wide screening found >7000 differentially methylated genes between node-negative and node-positive rectal cancer. Validation was performed on a subset of these genes and this confirmed hypermethylation of SNAP25, SOX7 and TIAM1 to be associated with favourable histological indices. This study has provided insight into the methylation patterns of rectal cancer and has identified novel prognostic biomarkers. Further work will determine their clinical usefulness in rectal cancer risk stratification.
20
Makino, Tomokazu. "Carbohydrate antigens as a risk factor for hematogenous recurrence of esophageal squamous cell carcinoma patients." Kyoto University, 2002. http://hdl.handle.net/2433/149342.
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Wilson, James Adams. "A New Volcanic Event Recurrence Rate Model and Code For Estimating Uncertainty in Recurrence Rate and Volume Flux Through Time With Selected Examples." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6435.
Повний текст джерелаАнотація:
Recurrence rate is often used to describe volcanic activity. There are numerous documented ex- amples of non-constant recurrence rate (e.g. Dohrenwend et al., 1984; Condit and Connor, 1996; Cronin et al., 2001; Bebbington and Cronin, 2011; Bevilacqua, 2015), but current techniques for calculating recurrence rate are unable to fully account for temporal changes in recurrence rate. A local–window recurrence rate model, which allows for non-constant recurrence rate, is used to calculate recurrence rate from an age model consisting of estimated ages of volcanic eruption from a Monte Carlo simulation. The Monte Carlo age assignment algorithm utilizes paleomagnetic and stratigraphic information to mask invalid ages from the radiometric date, represented as a Gaussian probability density function. To verify the age assignment algorithm, data from Heizler et al. (1999) for Lathrop Wells is modeled and compared. Synthetic data were compared with expected results and published data were used for cross comparison and verification of recurrence rate and volume flux calculations. The latest recurrence rate fully constrained by the data is reported, based upon data provided in the referenced paper: Cima Volcanic Field, 33 +55/-14 Events per Ma (Dohren- wend et al., 1984), Cerro Negro Volcano, 0.29 Events per Year (Hill et al., 1998), Southern Nevada Volcanic Field, 4.45 +1.84/-0.87 (Connor and Hill, 1995) and Arsia Mons, Mars, 0.09 +0.14/-0.06 Events per Ma (Richardson et al., 2015). The local–window approach is useful for 1) identifying trends in recurrence rate and 2) providing the User the ability to choose the best median recurrence rate and 90% confidence interval with respect to temporal clustering.
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Louzada, Martha. "Evaluating Risk of Recurrent Venous Thromboembolism During the Anticoagulation Period in Patients with Malignancy." Thesis, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19827.
Повний текст джерелаАнотація:
Background - Current guidelines suggest that all cancer patients with venous thrombosis be treated with long-term low molecular weight heparin. Whether treatment strategies should vary according to clinical characteristics remains unknown. // Systematic review -
A systematic review was performed to determine current understanding of the association between malignancy characteristics in patients with cancer-associated VTE and the risk of VTE recurrence. Four retrospective and 6 prospective studies were included. They suggest that lung cancer, metastases, and adenocarcinomas confer an increased the risk of recurrence and breast cancer a low risk. // Survey - I performed survey to evaluate thrombosis experts’ opinion about the low risk of VTE recurrence they would consider acceptable for patients with cancer- associated thrombosis 103 specialists participated. 80% of respondents agreed that a risk of recurrent VTE during anticoagulation below 7% is low enough. 92% agreed that a CPR that categorizes risk of recurrence is relevant. // Retrospective Study - I performed a single retrospective cohort study to assess the feasibility of derivation of a CPR that stratifies VTE recurrence risk in patients with cancer–associated thrombosis. The study included 543 patients. A multivariate analysis selected female, lung cancer and prior history of VTE as high risk predictors and breast cancer and stage I disease as low risk. // Conclusion - Patients with cancer-associated thrombosis do have varying risks of recurrent VTE depending on clinical characteristics.
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Miller, Daniel E. "Uptake of Screening and Recurrence of Bicuspid Aortic Valve and Thoracic Aortic Aneurysm among At-risk Siblings." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617107741801366.
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Natalucci, Valentina. "Effect of exercise in Breast Cancer and its association with tumor characteristics, risk factors for recurrence and lifestyle." Doctoral thesis, Urbino, 2018. http://hdl.handle.net/11576/2663506.
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Horikawa, Hiroyuki. "Development of a prediction model for child maltreatment recurrence in Japan: A historical cohort study using data from a Child Guidance Center." Kyoto University, 2016. http://hdl.handle.net/2433/217736.
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Huhtakangas, J. (Juha). "The influence of medication on the incidence, outcome, and recurrence of primary intracerebral hemorrhage." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514299438.
Повний текст джерелаАнотація:
Abstract Intracerebral hemorrhage (ICH) is the most pernicious form of stroke, with high mortality. Warfarin-associated ICH (WA-ICH) carries an even higher mortality rate. The major reason for the high mortality is explained by early hematoma growth. Warfarin use has rapidly increased with the aging of the population. We investigated temporal trends in the incidence and outcome of WA-ICHs. We found that although the proportion of warfarin users almost quadrupled in our population, the annual incidence and case fatality of WA-ICHs decreased. Management of ICH is mostly supportive. Prevention of associated complications is the issue in improving outcome. Hypertension is the most important modifiable risk factor for primary ICH, but little is known of the effect of preceding hypertension on outcome. Aggressive lowering of blood pressure is suggested to be a feasible treatment option. Reversal of warfarin anticoagulation with prothrombin complex concentrate (PCC) has been implemented as an acute treatment option for patients with WA-ICH. We found that the survival of WA-ICH subjects among our population improved after implementation of reversal of warfarin anticoagulation with PCC, likely because of the introduction of PCC. Because high mean arterial blood pressure (BP) at admission is an independent predictor of early death in patients with ICH, we explored its role in survival and poor outcome separately in normotensive subjects and subjects with treated and untreated hypertension. We found that despite their higher BP values at admission, subjects with untreated hypertension showed better survival and more often a favorable outcome after BP-lowering therapy than other patients. Studies on recurrent ICH are scarce. Underlying comorbidities, prior strokes, and drug-induced impaired platelet function may increase the risk for primary ICH (PICH). A lobar location of primary ICH may predict recurrent ICH. We investigated whether these factors predicted recurrence of PICH. In our study the annual incidence of recurrent ICH was 1.67%. Cumulative 5- and 10-year incidences were 9.6% and 14.2%. In multivariable analyses, prior ischemic stroke and diabetes proved to be independent predictors for recurrence. Moreover, diabetes was an independent risk factor for fatal recurrent PICH. Use of aspirin and serotonergic drugs did not significantly contribute to the riskTiivistelmä Aivoverenvuoto (ICH) on aivoverenkiertohäiriöistä vakavin. Sille on tyypillistä korkea kuolleisuus erityisesti varfariinihoitoon liittyen, ja eloonjääneetkin vammautuvat usein vakavasti. Verenvuodon koon kasvu alkuvaiheessa selittänee korkean kuolleisuuden. Väestön ikääntymisen myötä varfariinin käyttö on lisääntynyt nopeasti. Aivoverenvuodon hoito perustuu pitkälti ennusteen parantamiseen komplikaatioita estämällä. Verenpaine on tärkein hoidettavissa oleva riskitekijä, mutta tutkimustieto akuutin vaiheen verenpainetason merkityksestä ennusteeseen on vähäistä. Tehokasta verenpaineen alentamista alkuvaiheessa pidetään lupaavana hoitomenetelmänä. Vuodon koon kasvua pyritään rajoittamaan kumoamalla varfariinin antikoaguloiva vaikutus protrombiinikompleksi-konsentraatilla (PCC). Väitöstyössäni selvitän varfariinin käyttöön liittyvien aivoverenvuotojen (WA-ICH) esiintymistiheyttä ja ennustetta ajan myötä. Tutkin myös vuodon koon kasvun rajoittamista ja alkuvaiheen korkean verenpaineen alentamista hoitomenetelminä sekä selvitän, mitkä tekijät johtavat ICH:n uusiutumiseen. Totesimme WA-ICH:n ilmaantuvuuden ja tapauskuolleisuuden pienentyneen, vaikka varfariinin käyttö miltei nelinkertaistui väestössämme. Toisaalta WA-ICH -potilaiden kuolleisuus pieneni PCC-hoidon aloittamisen jälkeen, mahdollisesti sen ansiosta. Tutkiessamme riippumattomasti varhaista kuolemaa ennustavan korkean tulovaiheen verenpaineen roolia normaaliverenpaineisilla, hoidettua ja hoitamatonta verenpainetautia sairastavilla totesimme hoitamattomien hypertonia-potilaiden selvinneen akuutin vaiheen lääkehoidon myötä muita useammin hengissä ja hyväkuntoisina korkeista tulovaiheen verenpainearvoista huolimatta. Aivoverenvuodon uusiutumiseen vaikuttavista tekijöistä on vähän tutkimustietoa. Muu sairastavuus, aiemmat aivoverenkiertohäiriöt ja trombosyyttien toimintaan vaikuttavat lääkkeet saattavat lisätä ICH:n uusiutumisriskiä. Totesimme vuosittaisen uuden ICH:n esiintymistiheyden olevan 1,67 %. Aikaisempi aivoinfarkti ja diabetes osoittautuivat riippumattomiksi uusiutumista ennustaviksi riskitekijöiksi, minkä lisäksi diabetes ennusti kuolemaan johtavaa uutta ICH:a. Asetyylisalisyylihapon ja selektiivisten serotoniinin takaisinoton estäjien käyttäminen ei vaikuttanut merkittävästi uusiutumisriskiin
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Cordoba, Tibisay. "Family support program for families at risk of child maltreatment and child maltreatment recurrence in Los Angeles| A grant proposal." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1587892.
Повний текст джерелаАнотація:
The purpose of this project was to design a family support program, identify potential funding sources and write a grant to fund a program to reduce child maltreatment recurrence (CMR) for LIFT a non-profit agency located in Los Angeles, California. Research indicates risk factors such as neglect, poverty, single parent households, parental substance use and history of child welfare services, place children at increased risk of CMR and that comprehensive interventions are needed to address the multiple issues associated with CMR. The proposed program aims to provide supportive services to help families achieve greater economic self-sufficiency, leading families to be able to provide for the basic needs of their children and reducing the likelihood of CMR. Actual submission and/or funding of the grant was not a requirement for the completion of this project. Implications for social work practice are discussed.
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Abou, Chakra Claire Nour. "Développement d’outils de prédiction des complications et des récidives de l’infection à Clostridium difficile." Thèse, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/9911.
Повний текст джерелаАнотація:
Résumé : Depuis 2002, une augmentation des taux d’issues défavorables de l’infection à Clostridium difficile (ICD) a été attribuable à l’émergence de la souche NAP1/BI/R027. Il est indispensable d’identifier les facteurs de risque de développer des complications (ICDc) et des récidives (ICDr), et de pouvoir les prédire lors du diagnostic afin d’optimiser le traitement. Le projet de recherche a comme objectifs: i) l’identification des facteurs de risque pour le développement d’ICDc et ICDr et ii) le développement et la validation d’un outil de prédiction à partir de variables mesurées dans les 48h du diagnostic d’une ICD. Méthode: Une cohorte multicentrique prospective de patients adultes hospitalisés pour une ICD. Les données suivantes ont été recueillies: i) démographiques; ii) comorbidités; iii) traitements et procédures reçus dans les 2 mois avant le diagnostic; iv) paramètres cliniques, vi) biochimiques, hématologiques et vii) microbiologiques (ribotypage). Un suivi à 30 et 90 jours a été effectué. Les facteurs de risque ont été identifiés par des modèles multivariés de régression logistique et d'analyse de survie. La méthode de validation croisée a été utilisée pour la dérivation et la validation interne. Différents modèles ont été comparés selon l’aire sous la courbe ROC (ASC), l’erreur de prédiction (EP) et les paramètres de performance. Un score prédictif a été dérivé à partir du modèle optimal. Résultats: Au total, 1380 patients ont été inclus dont 96% suivis 90 jours. Une ICDc a été observée chez 8% et une ICDr chez 26%. La souche R027 représentait 52% des souches caractérisées. Les ICDc sont associées à un âge ≥80 ans, un rythme cardiaque >90/min, un rythme respiratoire >20/min, globules blancs (GB) <4 et ≥20×10[indice supérieur 9]/L, albumine sérique <25 g/L, urée sérique >7 mmol/L, et CRP ≥150 mg/L. Les ICDr sont associés à l'âge ≥ 65 ans, à l’exposition à des macrolides et/ou clindamycine, CRP ≥150 mg/L, R027, et une hospitalisation ≥14 jours suivant l'ICD. Un sous-groupe de 1038 cas complets a été utilisé pour la modélisation prédictive. Le modèle optimal contenait l’âge ≥80 ans, GB ≥12×10[indice supérieur 9]/L, albumine sérique <26 g/L et urée sérique >7 mmol/L, avec une ASC de 0,84 et une EP de 6%. Un score variant entre 0 et 17 points a été construit. En validation, un score >10 points présentait une sensibilité de 50% (IC[indice inférieur 95]% = 28-72), une spécificité de 85% (81-89), une valeur prédictive positive de 17% (7-27) et une valeur prédictive négative de 96% (94-99). Conclusions: En utilisant une large cohorte prospective multicentrique et plusieurs étapes de modélisation prédictive et de validation interne, nous avons identifié les facteurs associés aux ICDc et ICDr et dérivé un score prédictif des ICDc ayant une performance acceptable. Au moment du diagnostic de l’ICD, ces facteurs sont à considérer pour envisager le traitement le plus optimal afin de prévenir ces issues.Abstract : A significant increase in Clostridium difficile infection (CDI) unfavourable outcomes was observed since 2002 and was associated with the emergence of the strain NAP1/BI/R027. Identifying patients at high risk of developing complications (cCDI) and recurrences (rCDI), and predicting these outcomes early in the course of illness could improve clinical decision-making. The main objectives of this research were to: i) identify risk factors for cCDI and rCDI, and ii) develop and validate a clinical prediction rule for cCDI using predictors measured within 48h of CDI diagnosis. Methods: Adult in patients with confirmed CDI diagnosis in 10 acute care hospitals, were enrolled in a prospective cohort. Data at enrolment were collected : demographics, underlying illnesses, past medical and drug history (two months prior to CDI), clinical signs, blood tests, and C. difficile strain type. A follow-up was completed on day 30 and 90 after enrolment. Risk factors were identified by multivariate logistic regression and survival analyses. Split-sample technique was used for training and validation sets. Several predictive models were derived and assessed in both sets by AUC/ROC, prediction error (PE), and performance parameters. A predictive score was built using the optimal predictive model. Results: A total of 1380 patients were enrolled and 96% had 90 days follow -up. cCDI was observed in 8% and rCDI in 26%. R027 was identified in 52% of patients. Age ≥80 years, heart rate >90/min, respiratory rate >20/ min, white cell count <4 or ≥20 × 109/L, albumin <25 g/L, blood urea nitrogen >7 mmol/L, and C-reactive protein (CRP) ≥150 mg/L were independently associated with cCDI. Age ≥65 years, increased CRP, expos ure to macrolides/clindamycin, R 027, and prolonged hospital stay were associated with rCDI. A sub-group of 1038 complete cases was used for predictive modelling. In the training set, the optimal model with 6% PE and AUC 0.84 included age≥80, WBC≥12x10 [superscript 9]/L, BUN>7 mmol/L, and serum albumin <26 g/L. A predictive score was built with minimum 0 and maximum 17 points. A score >10 points showed 50% sensitivity (95%CI, 28-72), 85% specificity (81-89), 17% (7-27) positive predictive value, and 96% (94-99) negative predictive value. Conclusion: Through a large multicenter prospective cohort and multiple modelling approached, independent risk factors of complications and recurrence of CDI were identified. We derived a predictive score that included easily available meas ures at the bedside and showed acceptable performance. At time of CDI diagnosis, these predictors could be used by clinicians to identify patients at higher risk and adjust for the most optimal treatment that could prevent unfavourable outcomes.
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Robien, Kimberly Ziemer. "Folate status and risk of relapse following allogeneic hematopoietic cell transplant for chronic myelogenous leukemia /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/6598.
Повний текст джерела
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Dieng, Mbathio. "Investigating the effectiveness of a psycho-educational intervention to reduce fear of cancer recurrence in people at high-risk of developing another primary melanoma." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15574.
Повний текст джерелаАнотація:
Melanoma is the fourth most common cancer in Australia and its incidence continue to increase. The diagnosis and treatment of melanoma can impact upon many aspects of an individual’s life, including psychological and emotional well-being. In recognition of the psychological consequences of melanoma, Australian and New Zealand and other international guidelines for management of melanoma recommend psychological support be available alongside clinical care. This randomised controlled trial examined the efficacy of a psycho-educational intervention to reduce fear of cancer recurrence (FCR) and improve psychological adjustment in this patient group, compared to usual care. Methods: The intervention comprised a newly developed psycho-educational resource and three telephone-based psychology sessions over a one month period, timed in accordance with dermatological appointments. Participants were randomly assigned to the intervention (n=80) or usual care (n=84). Assessments were completed at baseline, one and six months following dermatological appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviours, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results: At six months, the intervention group reported lower FCR Severity, Triggers and Distress scores than the control group in the baseline-adjusted models; the between-group mean difference was -1.9 for FCR Severity (95% CI:-3.1,-0.7; p=0.002), -2.0 for FCR Triggers (95% CI:-3.3,-0.7; p=0.003) , and -0.7 for FCR Distress (95% CI:-1.3,-0.1; p=0.03). The decrease in FCR Severity (but not Triggers or Distress) remained statistically significant after adjusting for other covariates (p=0.04). At six months, the intervention group also reported lower stress (-1.6, 95% CI:-3.1,-0.2; p=0.03) and improved melanoma-related knowledge (1.7, 95% CI:0.8, 2.6; p=0.0004) compared to controls. Conclusion: This newly-developed, evidence-based, psycho-educational intervention was effective in reducing FCR and stress, and increasing melanoma-related knowledge in people at high risk of developing another melanoma.
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Olsen, Jens, and Torsten Muhrbeck. "Surgical Removal of Ameloblastoma and Keratocystic Odontogenic Tumors in Maxilla and Mandible, a Literature Review on Surgical Techniques and Risk of Recurrence." Thesis, Umeå universitet, Institutionen för odontologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128183.
Повний текст джерелаАнотація:
This literature review examines the literature on surgical management of ameloblastoma and keratocystic odontogenic tumours (KCOT). KCOT represent 3 % - 11 % of all the cystic lesions in the jaws and ameloblastoma 11 % of the odontogenic tumours. Treatment involves removal of the tumours by means of enucleation, curettage, marsupialization or resection. The first three can be combined with each other or with the adjunctive therapies: applications of Carnoy´s solution or cryotherapy. The aim of this literature review is to evaluate the risk of complications correlated to different surgical techniques for removal of KCOT or ameloblastoma. A search was performed in PubMed based on our keywords (Marsupialization, decompression, fenestration, enukleation, KCOT, OKC, KOT, keratocystic odontogenic tumor, odontogenic keratocyst, ameloblastoma, outcome, follow-up, relapse, prognosis, recurrence). The data was managed with Excel. Twenty articles met our criteria: 12 articles reported KCOT in 667 patients and 8 articles reported 191 patients concerning Ameloblastoma. The articles almost exclusively presented the risk of recurrence for different treatment modalities. Subsequently the results mainly contain recurrence rates for different surgical techniques. 412 KCOT patients received enucleation alone and 92 recurred, resulting in a recurrence rate of 22.3 %. 91 patients with ameloblastoma received resection and four recurred, resulting in a recurrence rate of 4.4 %. This review fails to identify any reliable evidence on recurrence rates in relation to treatment modalities for KCOT and ameloblastoma. Further prospective controlled clinical trials are essential to address this important issue.
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Hopfner, Yan Yuh [Verfasser]. "Zinc transporter 8 autoantibodies are a risk factor for type 1 diabetes recurrence in recipients of simultaneous pancreas kidney transplants. / Yan Yuh Hopfner." Ulm : Universität Ulm. Medizinische Fakultät, 2014. http://d-nb.info/1058401815/34.
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Dernevik, Mats. "Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-095-8/.
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34
Weinberg, Lori Elizabeth. "Lymphovascular space invasion is an isolated poor prognostic factor for recurrence and survival among women with intermediate to high-risk early stage endometrioid endometrial cancer: An exploratory retrospective cohort study." Case Western Reserve University School of Graduate Studies / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1339205202.
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Phayal, Anup. "MASS FEARS, STRONG LEADERS AND THE RISK OF RENEWED CONFLICT: THREE ESSAYS ON POST-CONFLICT ELECTIONS." UKnowledge, 2016. http://uknowledge.uky.edu/polysci_etds/19.
Повний текст джерелаАнотація:
Countries emerging out of armed conflicts face immense challenges in their efforts to build electoral democracies. Contrary to our intuition that elections can transform violent competition to peaceful political contests, past research suggests that holding post-conflict elections only increases the chance of renewed violence. Why are elections unable to build sustainable democracies as expected? In this dissertation, I examine the question by focusing on two levels of analysis. First, I study the effects of violence on political behavior of mass publics at the individual level using the World Values survey Dataset. I argue that citizens are more inclined to support undemocratic leaders, when they are faced with threats from armed violence. Empirically, I find that presence of pre-election violence in post-conflict elections leads voters to prefer parties that are stronger in terms of their violence-wielding capacities over more moderate and peaceful parties. Second, I investigate how such an outcome might influence the risk of renewed conflicts in a country emerging out of armed conflict. The hypothesized mechanism can only be described as tragic. At individual level, fearful voters support violent parties mainly to maintain the status quo, fearing that parties with a violent reputation are likely to renew conflict if they lose the election. Tragically, however, placing undemocratic and violent parties in power only increases the likelihood of renewed conflicts. I test this expectation using an event history model to analyze all post-conflict countries from 1950 to 2010 and find that the presence of pre-election violence in a country increases its risk of renewed armed conflicts. The study has important implication for policymakers and election monitoring bodies. Rather than the current practice of observing only a single event Election Day, this study emphasizes the importance of creating a secure environment during the pre-election phase, about six months prior to the first election, in order to achieve a sustainable peace in post-conflict countries.
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Stumm, Laura [Verfasser], and Guido [Akademischer Betreuer] Sauter. "Strong expression of the neuronal transcription factor FOXP2 ist linked to an increased risk of early PSA recurrence in ERG fusion-negative cancers / Laura Stumm. Betreuer: Guido Sauter." Hamburg : Staats- und Universitätsbibliothek Hamburg, 2013. http://d-nb.info/1045024619/34.
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Colabrese, Hannah Leigh. "Impact of Cleft Lip with or without Cleft Palate on Parental Knowledge of Risk and Opinions of Genetic Testing." Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1277860682.
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Razavi, Amir Reza. "Applications of Knowledge Discovery in Quality Registries - Predicting Recurrence of Breast Cancer and Analyzing Non-compliance with a Clinical Guideline." Doctoral thesis, Linköping : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10142.
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Johansson, Elias. "Carotid stenosis." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-46396.
Повний текст джерелаАнотація:
Carotid stenosis is one of several causes of ischemic stroke and entails a high risk of ischemic stroke recurrence. Removal of a carotid stenosis by carotid endarterectomy results in a risk reduction for ischemic stroke, but the magnitude of risk reduction depends on several factors. If the delay between the last symptom and carotid endarterectomy is less than 2 weeks, the absolute risk reduction is >10%, regardless of age, sex, or if the degree of carotid stenosis is 50–69% or 70–99%. Thus, speed is the key. However, if many patients suffers an ischemic stroke recurrence within the first 2 weeks of the presenting event, an additional benefit is likely be obtained if carotid endarterectomy is performed even earlier than within 2 week after the presenting event. Carotid endarterectomy for asymptomatic carotid stenoses carries a small risk reduction for stroke. Screening for asymptomatic carotid stenosis requires a prevalence of >5% in the examined population, i.e., higher than in the general population; however, directed screening in groups with a prevalence of >5% is beneficial. The aims of this thesis were to investigate the length of the delay to carotid endarterectomy, determine the risk of recurrent stroke before carotid endarterectomy, and determine if a calcification in the area of the carotid arteries seen on dental panoramic radiographs is a valid selection method for directed ultrasound screening to detect asymptomatic carotid stenosis. Consecutive patients with a symptomatic carotid stenosis who underwent a preoperative evaluation aimed at carotid endarterectomy at Umeå Stroke Centre between January 1, 2004–March 31, 2006 (n=275) were collected retrospectively and between August 1, 2007–December 31, 2009 (n=230) prospectively. In addition, 117 consecutive persons, all preliminarily eligible for asymptomatic carotid endarterectomy and with a calcification in the area of the carotid arteries seen on panoramic radiographs, were prospectively examined with carotid ultrasound. The median delay between the presenting event and carotid endarterectomy was 11.7 weeks in the first half year of 2004, dropped to 6.9 weeks in the first quarter year of 2006, and had dropped to 3.6 weeks in the second half year of 2009. The risk of ipsilateral ischemic stroke recurrence was 4.8% within 2 days, 7.9% within 1 week, and 11.2% within 2 weeks of the presenting event. For patients with a stroke or transient ischemic attack as the presenting event, this risk was 6.0% within 2 days, 9.7% within 1 week, and 14.3% within 2 weeks of the presenting event. For the 10 patients with a near-occlusion, the risk of ipsilateral ischemic stroke recurrence was 50% at 4 weeks after the presenting event. Among the 117 persons with a calcification in the area of the carotid arteries seen on panoramic radiographs, eight had a 50–99% carotid stenosis, equalling a prevalence of 6.8% (not statistically significantly over the pre-specified 5% threshold). Among men, the prevalence of 50–99% carotid stenosis was 12.5%, which was statistically significantly over the pre-specified 5% threshold. In conclusion: The delay to carotid endarterectomy was longer than 2 weeks. Additional benefit is likely to be gained by performing carotid endarterectomy within a few days of the presenting event instead of at 2 weeks because many patients suffer a stroke recurrence within a few days; speed is indeed the key. The finding that near-occlusion entails an early high risk of stroke recurrence stands in sharp contrast to previous studies; one possible explaination is that this was a high-risk period missed in previous studies. The incidental finding of a calcification in the area of the carotid arteries on a panoramic radiograph is a valid indication for carotid ultrasound screening in men who are otherwise eligible for asymptomatic carotid endarterectomy.
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Huang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/730.
Повний текст джерелаАнотація:
Background: Venous thromboembolism (VTE), comprising the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common acute cardiovascular event associated with increased long-term morbidity, functional disability, all-cause mortality, and high rates of recurrence. Major advances in identification, prophylaxis, and treatment over the past 3-decades have likely changed its clinical epidemiology. However, there are little published data describing contemporary, population-based, trends in VTE prevention and management.
Objectives: To examine recent trends in the epidemiology of clinically recognized VTE and assess the risk of recurrence after a first acute episode of VTE.
Methods: We used population-based surveillance to monitor trends in acute VTE among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) from 1985 through 2009, including in-hospital and ambulatory settings.
Results: Among 5,025 WMSA residents diagnosed with acute PE and/or lower-extremity DVT between 1985 and 2009 (mean age = 65 years), 46% were men and 95% were white. Age- and sex-adjusted annual event rates (per 100, 000) of clinically recognized acute first-time and recurrent VTE was 142 overall, increasing from 112 in 1985/86 to 168 in 2009, due primarily to increases in PE occurrence. During this period, non-invasive diagnostic VTE testing increased, vi while treatment shifted from the in-hospital (chiefly with warfarin and unfractionated heparin) to out-patient setting (chiefly with low-molecular-weight heparins and newer anticoagulants). Among those with community-presenting first-time VTE, subsequent 3-year cumulative event rates of key outcomes decreased from 1999 to 2009, including all-cause mortality (41% to 26%), major bleeding episodes (12% to 6%), and recurrent VTE (17% to 9%). Active-cancer (with or without chemotherapy), a hypercoagulable state, varicose vein stripping, and Inferior vena cava filter placement were independent predictors of recurrence during short- (3-month) and long-term (3-year) follow-up after a first acute episode of VTE. We developed risk score calculators for VTE recurrence based on a 3-month prognostic model for all patients and separately for patients without active cancer.
Conclusions: Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the disease burden from VTE in residents of central Massachusetts remains high, with increasing annual events. Declines in the frequency of major adverse outcomes between 1999 and 2009 were reassuring. Still, mortality, major bleeding, and recurrence rates remained high, suggesting opportunities for improved prevention and treatment. Clinicians may be able to use the identified predictors of recurrence and risk score calculators to estimate the risk of VTE recurrence and tailor outpatient treatments to individual patients.
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Huang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2011. http://escholarship.umassmed.edu/gsbs_diss/730.
Повний текст джерелаАнотація:
Background: Venous thromboembolism (VTE), comprising the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common acute cardiovascular event associated with increased long-term morbidity, functional disability, all-cause mortality, and high rates of recurrence. Major advances in identification, prophylaxis, and treatment over the past 3-decades have likely changed its clinical epidemiology. However, there are little published data describing contemporary, population-based, trends in VTE prevention and management.
Objectives: To examine recent trends in the epidemiology of clinically recognized VTE and assess the risk of recurrence after a first acute episode of VTE.
Methods: We used population-based surveillance to monitor trends in acute VTE among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) from 1985 through 2009, including in-hospital and ambulatory settings.
Results: Among 5,025 WMSA residents diagnosed with acute PE and/or lower-extremity DVT between 1985 and 2009 (mean age = 65 years), 46% were men and 95% were white. Age- and sex-adjusted annual event rates (per 100, 000) of clinically recognized acute first-time and recurrent VTE was 142 overall, increasing from 112 in 1985/86 to 168 in 2009, due primarily to increases in PE occurrence. During this period, non-invasive diagnostic VTE testing increased, vi while treatment shifted from the in-hospital (chiefly with warfarin and unfractionated heparin) to out-patient setting (chiefly with low-molecular-weight heparins and newer anticoagulants). Among those with community-presenting first-time VTE, subsequent 3-year cumulative event rates of key outcomes decreased from 1999 to 2009, including all-cause mortality (41% to 26%), major bleeding episodes (12% to 6%), and recurrent VTE (17% to 9%). Active-cancer (with or without chemotherapy), a hypercoagulable state, varicose vein stripping, and Inferior vena cava filter placement were independent predictors of recurrence during short- (3-month) and long-term (3-year) follow-up after a first acute episode of VTE. We developed risk score calculators for VTE recurrence based on a 3-month prognostic model for all patients and separately for patients without active cancer.
Conclusions: Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the disease burden from VTE in residents of central Massachusetts remains high, with increasing annual events. Declines in the frequency of major adverse outcomes between 1999 and 2009 were reassuring. Still, mortality, major bleeding, and recurrence rates remained high, suggesting opportunities for improved prevention and treatment. Clinicians may be able to use the identified predictors of recurrence and risk score calculators to estimate the risk of VTE recurrence and tailor outpatient treatments to individual patients.
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Vicente, Carolina de Jesus Pardal. "Avaliação de fatores de risco para a evolução clínica e prognóstico a curto e longo prazo de hérnias perineais : estudo retrospetivo em 75 animais da espécie Canis familiaris." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2018. http://hdl.handle.net/10400.5/16431.
Повний текст джерелаАнотація:
Dissertação de Mestrado Integrado em Medicina VeterináriaHérnia perineal é uma entidade clínica reconhecida em várias espécies, especialmente no cão macho não castrado de idade adulta a avançada, surgindo por enfraquecimento e separação dos componentes do diafragma pélvico, o que permite a passagem de estruturas entre eles. Pensa-se que se trate de uma entidade de etiologia multifatorial, tendo sido implicados diversos fatores: atrofia dos músculos do diafragma pélvico, alterações retais, desequilíbrios hormonais, excesso de pressão no diafragma pélvico e efeito da relaxina prostática sobre as fibras musculares. O diagnóstico é essencialmente clínico e, embora uma abordagem médica possa ser tentada, a resolução cirúrgica é o tratamento de eleição, havendo diversas técnicas de herniorrafia descritas para o efeito. A realização concomitante de orquiectomia, embora não consensual, está indicada. Técnicas adjuvantes, como colopexia, cistopexia e vasopexia, podem também ser necessárias. As complicações póscirúrgicas mais frequentes incluem: tenesmo fecal, incontinência fecal e urinária, prolapso retal, alterações da região intervencionada, claudicação e recidiva. A avaliação de eventuais fatores de risco para a evolução clínica e o prognóstico desta afeção foi o objetivo primordial do presente trabalho, realizado retrospetivamente numa amostra de 75 canídeos machos (N=75) diagnosticados com hérnia perineal. Os resultados obtidos mostraram que a presença de tenesmo fecal pré-cirúrgico, quistos prostáticos e retroflexão da bexiga estão associados a uma maior prevalência de hérnias bilaterais. Quanto ao prognóstico a curto (complicações pós-cirúrgicas) e a longo (recidiva) prazo, verificou-se que a realização de tratamento médico previamente ao tratamento cirúrgico é contraditória, pois associa-se a uma diminuição das complicações e concomitantemente a um aumento da probabilidade de recidiva. A abordagem cirúrgica parece influenciar o resultado final do curso clínico da patologia, embora sem significância estatística, devendo optar-se pela realização de técnicas adjuvantes em conjunto com a herniorrafia, e no caso particular das hérnias bilaterais, por uma herniorrafia bilateral faseada.
ABSTRACT - EVALUATION OF RISK FACTORS FOR THE CLINICAL EVOLUTION, SHORT AND LONG TERM PROGNOSIS OF PERINEAL HERNIAS – RETROSPECTIVE STUDY IN 75 ANIMALS OF THE CANIS FAMILIARIS SPECIES - Perineal hernia is a clinical entity recognized in several species, especially in older intact male dogs, appearing in consequence of fragility and separation of the components of the pelvic diaphragm, thus allowing passage of structures between them. It is thought to be an entity of multifactorial origin, and several factors have been implied: muscle atrophy of the pelvic diaphragm, rectal abnormalities, hormonal imbalance, excessive pressure on the pelvic diaphragm and prostatic relaxin’s effects on muscle fiber weakening. Diagnosis is mainly clinical and, although a medical approach can be attempted, surgical closure is the treatment of choice, with multiple herniorrhaphy techniques available. Orchiectomy simultaneous to the herniorrhaphy, although not consensual, is indicated. Adjuvant techniques, such as colopexy, cystopexy and vasopexy, may also be necessary. The most common surgical complications include: fecal tenesmus, fecal and urinary incontinence, rectal prolapse, incisional alterations, lameness, and recurrence. Evaluation of risk factors for the clinical evolution and prognosis of this disease was the primary goal of the present study, retrospectively made with a sample of 75 male dogs (N=75) diagnosed with perineal hernia. The results showed that the presence of pre-surgical tenesmus, prostatic cysts and bladder retroflexion are associated with a higher prevalence of bilateral hernias. Regarding to short (post-surgical complications) and long-term (recurrence) prognosis, performing medical treatment before surgical repair was contradictory, with reduction of complications but an increasing probability of recurrence. Surgical approach seems to have an influence on the outcome, although without statistical relevance, being preferable to perform adjuvant techniques with the herniorrhaphy and, in the particular case of bilateral hernias, to privilege a staged approach.
N/A
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Ligier, Fabienne. "Adolescence et tentative de suicide : devenir, soutien social, facteurs de risque et prévention de la récidive suicidaire." Thesis, Université de Lorraine, 2016. http://www.theses.fr/2016LORR0184/document.
Повний текст джерелаАнотація:
Contexte : La tentative de suicide (TS) concerne 8 à 10 % des adolescents et la récidive précoce 14 à 20% des adolescents. La TS peut avoir des répercussions à long terme chez les adolescents, tant au niveau scolaire/professionnel, qu’au niveau affectif et psychique. Objectifs : 1) Décrire le devenir psychosocial des suicidants et le poids de la récidive sur ce devenir, 2) étudier l’impact du fait de ne plus être joignable par l’équipe de soins 1 an après la TS et 3) étudier les modalités de communication, le soutien social et la santé perçue des jeunes suicidants. Méthode : 1) 309 sujets ont été inclus avec une évaluation au moment du geste et à 10 ans, 2) étude de l’association du fait de ne plus être joignable par l’équipe de soins avec la récidive suicidaire chez 249 patients, 3) modalité d’utilisation des moyens de communication, perception du soutien social et santé perçue de 58 adolescents suicidants. Résultats : Devenus adultes, les jeunes suicidants ont un devenir psychosocial altéré, d’autant plus lorsqu’ils avaient récidivé durant l’année suivant le geste d’inclusion. Le fait de ne plus être joignable par les soignants un an après la TS d’inclusion majore le risque de récidive suicidaire dans les 10 ans. Chez les suicidants, l’utilisation des SMS est privilégiée pour « rester en lien » avec les proches ; soutien social et santé perçue sont évalués de manière moins positive que chez leurs pairs. Perspectives : Dans un but de prévention de la récidive, nous avons développé un dispositif de veille s’appuyant sur l’envoi de SMS qui sera évalué dans un essai randomisé contrôléBackground: Suicide attempt (SA) concerns 8% to 10% of adolescents and SA recurrence within the year 14% to 20% of adolescents. SA of young patients may have implications over the long term on an academic/professional level, as well as on an affective and psychic level. Objectives: 1) To describe psychosocial outcomes of SAers and the weight of recurrence on these outcomes, 2) to study the impact of losing contact with caregivers during the year following SA, and 3) to study how young SAers use means of communication, and perceive social support they receive and their health-related quality of life. Methods: Three researches were carried out on adolescent SAers. 1) 309 SAers were evaluated at time of SA and 10 years after SA, 2) study of the correlation between a loss of contact with caregivers and SA recurrence occurring between 1 to 10 years after the initial SA of 249 young patients, 3) how 58 SAers use means of communication, and perceive social support they receive and their health-related quality of life. Results: As an adult, the psychosocial situation of young SAers is impaired, especially for those who have a recurrence of SA during the year after index SA. The risk of recurrence increases in the ten years following index SA for early SAers, and in the year following index SA when contact has been lost with caregivers. SAers preferentially use SMS to “keep in touch” with relatives and they assess on a less positive note than peers their social support and health-related quality of life. Perspectives: We developed a monitoring device based on SMS sending in order to prevent SA recurrence which will be assessed through a randomized controlled clinical trial
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Hickey, Mary Beth, and Karen Eva Smithson. "Risk factors associated with recurrent child maltreatment." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2900.
Повний текст джерелаАнотація:
The purpose of this study was to identify factors that contribute to the recurrence of child maltreatment within a variety of families. The following discussion addresses the safety and security of children, child protective services, cultural sensitivity, and perception of poverty.
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Hondo, Fábio Yuji. "Fatores preditivos para recidiva local e para ressecção incompleta de adenocarcinoma gástrico precoce tratado através da exérese endoscópica." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5154/tde-20062007-161637/.
Повний текст джерелаАнотація:
O câncer gástrico precoce é definido como adenocarcinoma que não ultrapassa a camada submucosa, independentemente o acometimento linfonodal. O diagnóstico é feito através do exame de endoscopia digestiva alta e da avaliação histopatológica. Pode ser tratado através de mucosectomia endoscópica, sendo reconhecidos vários fatores que influenciam a chance de cura após a ressecção. Quando o adenocarcinoma gástrico precoce bem diferenciado está à restrito a mucosa, com margens de ressecção livres de neoplasia, sem ulceração histológica, invasão linfática ou venosa é alta a chance de cura após a ressecção endoscópica. A freqüência de recidiva local nestes casos varia de 2,8% a 5,7%. Por outro lado, a expressão de antígenos por células tumorais detectadas através da imunohistoquímica pode indicar o comportamento biológico dos tumores. O carcinoma gástrico precoce tipo diferenciado pode apresentar propriedades fenotípicas diferentes que se correlacionam com a expressão de mucinas. Através da expressão de mucinas é possível estratificar o adenocarcinoma diferenciado em tipo intestinal, gástrico, misto ou indeterminado. O objetivo deste estudo foi avaliar os fatores preditivos para a ressecção incompleta e recidiva local do câncer gástrico precoce tratado através de mucosectomia endoscópica e com acompanhamento superior a um ano. De junho de 1994 a dezembro de 2005, avaliaram-se 46 pacientes com câncer gástrico precoce submetidos a 47 mucosectomias endoscópicas. Através da análise de dados de prontuário, identificaram-se possíveis fatores preditivos para a ressecção endoscópica incompleta e para a recidiva local. Vinte e dois pacientes com critérios para alta probabilidade de cura foram avaliados prospectivamente em relação aos fatores para recidiva e submetidos a perfil imunohistoquímico das lesões ressecadas. Houve recuperação de peças ressecadas em 18 (81,8%) casos. Neste grupo, houve recidiva local em cinco (27,7%) casos. Assim, os pacientes foram avaliados pelos dados demográficos, endoscópicos e histopatológicos. As mucosectomias endoscópicas foram consideradas como ressecção completa ou incompleta. No grupo ressecção completa, os pacientes foram divididos nos subgrupos com ou sem recidiva. Os pacientes com critérios de alta probabilidade para cura foram divididos nos grupos com ou sem recidiva e comparados pelos dados demográficos, endoscópicos, e histopatológicos e imunohistoquímico. As peças ressecadas foram avaliadas quanto à expressão dos marcadores Muc-2, Muc-5a, CD-10, p-53 e Ki-67. O tempo médio de seguimento foi de 69,4 meses ± 36,5 meses. Sobrevida em cinco anos foi de 84,78%. Observaram-se sete (15,21%) óbitos. Houve ressecção completa em 36 casos (76,6%). Foram fatores preditivos de ressecção incompleta, as localizações em parede posterior de terço superior e inferior do estômago (p= 0,035), o tipo histológico indiferenciado (p=0,021), o tamanho da lesão maior que dois centímetros (p= 0,022) e o número de fragmentos maiores ou iguais a dois fragmentos (p= 0,013). Em análise estatística multivariada, o tipo histológico indiferenciado (OR= 0,8; IC (95%)= 0,036-0.897) e números de fragmentos (OR=7,34; IC (95%) = 1.266- 42.629) foram fatores preditivos independentes para ressecção incompleta. No grupo ressecção completa, observou-se que quanto maior o tamanho da lesão, maior o número de fragmentos ressecados (p=0,018). Houve recidiva local em 9 casos (25%). Como fator preditivo para recidiva local, destaca-se a técnica tipo cap com 5/7 casos (71,4%) (p=0,006). Na análise dos pacientes com critérios de alta probabilidade de cura, os dados demográficos (sexo, idade e raça), endoscópicos (tipo macroscópico, localização, número de fragmentos ressecados, técnica de ressecção empregada) e histopatológico (tamanho da lesão e nível de invasão) não mostraram diferença estatística significativa entre os grupos sem ou com recidiva. A análise imunohistoquímica revelou que o marcador Muc-5a esteve presente em 4/5 (80%) dos casos do grupo com recidiva (p=0,026) e quando se estratificaram os casos pela expressão de mucinas, observou-se que o tipo misto se apresentou em 4/5 (80%) casos no grupo com recidiva e o tipo intestinal em 10/13(76,9%) casos no grupo sem recidiva (p=0,004). O adenocarcinoma indiferenciado e números de fragmentos são fatores preditores para ressecção incompleta. O tamanho e a localização da lesão também foram fatores preditores de ressecção incompleta, porém, não de forma independente. A recidiva local teve como fator preditivo o tipo de técnica. O estudo imunohistoquímico se mostrou importante na presunção de recidiva local, nos casos em que os critérios para alta probabilidade de cura foram respeitados. O adenocarcinoma gástrico com expressão das mucinas para o fenótipo do tipo misto se mostrou como fator preditivo para recidiva local do câncer gástrico precoce.Endoscopic mucosal resection (EMR) has recently become an accepted treatment for early gastric cancer. The histopathologic criteria that are used to define curative endoscopic resection include: intramucosal well-differentiated adenocarcinoma, lateral and deep margins free of tumor, no histologic ulceration, and lastly, no venous or lymphatic emboli. These criteria were defined by a large series of EMR from Japanese centers. Local neoplastic recurrence has been described in up to 6% of cases even when all of the above mentioned criteria are met. On the other hand, the antigen expression of neoplastic cells is related to the biologic behavior of several tumors. The aim of this study was evaluate the factors that predict incomplete resection and local recurrence of early gastric cancer treated by EMR followed up for at least one year in a Western tertiary referral center. It was also evaluated the role of different type of mucins, p53 and ki-67 expression as predictive factors of recurrence even when the standard histopathologic criteria for cure were met. The patients were evaluated retrospectively from June 1994 to December 2005. Forty six patients (23 female and 23 male; mean age 69 ± 14.1y) with early gastric cancer were submitted to EMR. Twenty-two patients with a diagnosis of early gastric cancer were considered cured by EMR were evaluated prospectively for local reccurrence. Local recurrences occurred in five (22.7%) of them. It was possible to perform immunohistochemistry panel in 18 (81.8%) resected specimens. Demographic data (gender, age and race), endoscopic (macroscopic classification, localization, number of resected fragments and technique employed) were retrospectively collected. Histopathologic data (size of tumor, depth of invasion and adenocarcinoma classification) were prospectively assessed by one senior pathologist blinded to the previous diagnosis. Resection was considered incomplete when the lateral or deep margins of the specimen proved positive for tumor. In the complete resection group, patients were followed up, and at the end of this study were divided into two groups: patients recurrence with and without local recurrence. The patients with histopathologic criteria for cure were divided into two groups: with local recurrence and without local recurrence. These were then compared by demographic, endoscopic, histologic and immunohistochemistry profiles. Expression of Muc-2, Muc-5a, CD-10, p-53 and ki-67 were analyzed. Mucin expression allowed a reclassification of the well- differentiated gastric cancer in intestinal, gastric, mixed or null phenotypes. The mean follow up was 69.4 months ± 36.5 months. Five-year survival was 84.78%. Seven (15.21%) patients died from other diseases not related to the gastric lesion. Complete resection was possible in 36 cases (76,6%). Predictive factors for incomplete resection were localization (p= 0,035), histologic type (p=0,021), size of the lesion (p= 0,022) and number of fragments resected (p= 0,013). In the multivariate statistical analysis, the undifferentiated histologic type (OR= 0,8; IC (95%)= 0,036-0.897) and piece-meal resection (OR=7,34; IC (95%) = 1.266-42.629) were independent risk factors for incomplete resection. On the other hand, in the complete resection group, it was noted that lesions >2cm were more frequently resected in piece-meal fashion (p=0,018). Local recurrence occured in 9 cases (group I) (25%). The cap technique was the only predictive factor for local recurrence (5/7 cases - 71,4%, p=0,006). In the group of patients with histopathologic criteria for cure, the demographic (gender, age and race), endoscopic (macroscopic classification, localization, total number of resected fragments, EMR technique) and histopathologic findings (size of the tumor and depth of invasionm1, m2,m3), p-53 and ki-67 expressions did not correlate with neoplastic recurrence. Muc-5a marker was expressed in 80%(4/5) of the cases in group I and in 15.4% (12/13) of the cases in group II (p=0,026). The mixed phenotype (Muc-2 and Muc- 5a positive) was found in 80%(4/5) of the cases of group I and the intestinal type (Muc-2 positive and Muc-5a negative) in 76.9% (10/13) of group II (p=0,004). In conclusion, the undifferentiated adenocarcinoma and piece-meal resection were independent risk factors for incomplete resection. The cap technique for EMR was related to local recurrence after complete resection. Larger lesions are usually resected in more than one fragment. The expression of Muc-5a and the mixed phenotype of well-differentiated adenocarcinoma were related to a higher probability of local recurrence after EMR of early gastric lesions considered cured by the endoscopic intervention.
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Almeida, Gisele Caravina de. "Análise das frequências dos subgrupos moleculares dos meduloblastomas e associações com possíveis fatores prognósticos." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-13012015-110401/.
Повний текст джерелаАнотація:
INTRODUÇÃO: Meduloblastoma é o tumor cerebral embrionário maligno mais comum da infância. O esquema de tratamento atual inclui ressecção cirúrgica, radioterapia e quimioterapia. Embora a taxa de sobrevida global tenha aumentado nos últimos anos, em decorrência do tratamento os sobreviventes frequentemente sofrem com sequelas de ordem neurológica, endocrinológica e social. O esquema de classificação de risco atual não considera a heterogeneidade existente entre os pacientes e entre os tumores. No entanto, estudos recentes reconheceram quatro subgrupos moleculares distintos de meduloblastomas (WNT, SHH, Grupo 3 e Grupo 4), que confirmam essa heterogeneidade e formam, em conjunto, o melhor fator definidor de prognóstico para essa neoplasia. Esses subgrupos poderiam ser identificados através de marcadores imuno-histoquímicos representativos para cada um deles. O presente estudo teve como objetivo definir a frequência dos subgrupos de meduloblastomas na população brasileira através da positividade imuno-histoquímica para esses marcadores e analisar a frequência de positividade de outros marcadores também descritos como tendo importância prognóstica. MÉTODOS: 61 casos de meduloblastoma foram submetidos a estudo imuno-histoquímico para 5 marcadores descritos como tendo importância prognóstica (p53, ciclinaD1, p16, bcl2 e HER2) e para 5 marcadores descritos como representativos dos subgrupos moleculares de meduloblastoma (DKK1 e ?-catenina (subgrupo WNT), SFRP1 (subgrupo SHH), NPR3 (Grupo 3) e KCNA1 (Grupo 4). Os resultados foram correlacionados com os dados demográficos, histológicos e clínicos. RESULTADOS: Nenhum dos 10 marcadores imuno-histoquímicos revelou-se fator prognóstico em meduloblastoma. Os 5 marcadores representativos dos subgrupos moleculares apresentaram positividade para mais de 1 marcador ou negatividade para todos os marcadores na maioria dos casos. Apesar disso, foi possível classificar 22 casos nos quatro subgrupos de meduloblastomas por meio da positividade exclusiva para esses marcadores. Os resultados das análises entre os subgrupos e as respectivas frequências quanto às variáveis demográficas, histológicas, clínicas e prognósticas foram semelhantes aos descritos na literatura. CONCLUSÕES: Os marcadores imuno-histoquímicos analisados não apresentaram valor prognóstico nesta casuística, e os marcadores descritos como representativos dos quatro subgrupos moleculares mostraram-se pouco sensíveis e específicos para classificar os meduloblastomasINTRODUCTION: Medulloblastoma, a malignant embryonal brain tumor, is the most frequently occurring brain tumor in children. Treatment strategy involves surgery, radiotherapy and chemotherapy. Overall survival rate has increased in recent years, but survivors often present neurological sequelae, as well as endocrine and social disorders, as a result of the treatment. Medulloblastoma is no longer consider a single disease: standard risk stratification disregards heterogeneity related to both patients and tumors, and recent work has generated a molecular stratification of the medulloblastomas into 4 distinct subgroups (WNT, SHH, Group 3 and Group 4), currently considered the best prognostic factor. Representative immunohistochemical markers could help identify each one of those subgroups. Our study aimed to establish the frequency of subgroups of medulloblastomas, in brazilian population, by immunohistochemical positivity for its specific markers, and also analyze the frequency of positivity for other markers that are equally implicated in prognosis. METHODS: We evaluated immunohistochemistry expression of 5 markers - DKK1 and ?-catenin (subgroup WNT), SFRP1 (subgroup SHH), NPR3 (Group 3) and KCNA1 (Group 4) - to determine molecular subgroup affiliation of 61 cases of medulloblastomas, along with 5 other markers widely used in daily practice that may have prognostic value in medulloblastomas (p53, cyclinD1, p16, bcl2 and HER2). Results were correlated to demographic, histological and clinical data. RESULTS: None of the 10 immunohistochemical markers investigated proved to be significant prognostic factor in our series. Five representative immunohistochemical markers of the molecular subgroups exhibited positivity for more than one marker or negativity for all markers in most cases. Nevertheless, we manage to determine molecular affiliation in one of the 4 subgroups in 22 cases, due to their exclusive positivity related to the representative markers. Regarding frequencies of occurrence, demographics, histological characteristics, clinical aspects and prognosis, our results related to the 22 cases were similar to those reported in the literature. CONCLUSIONS: Immunohistochemical markers considered representative for each of the 4 molecular subgroups were poorly sensitive and specific, and others markers evaluated did not reveal prognostic value in our series
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Schütz-Fransson, Ulrike. "Fixed mandibular retainers : a controlled 12-year follow-up." Licentiate thesis, Malmö universitet, Odontologiska fakulteten (OD), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-7756.
Повний текст джерелаАнотація:
Fixed retainer after orthodontic treatment is an increasing retention appliance. For the mandibular incisors there are two different fixed retainers that are commonly used, either a canine-to-canine retainer bonded only to the canines or a twistflex retainer bonded to each of the mandibular incisors and canines. Increased mandibular incisor irregularity seems to be a continuous process throughout life even in untreated patients. The natural physiological changes during aging causes changes like those that occur after orthodontic treatment and the removal of retainers. There are few long-term studies that have compared patients who have had a mandibular fixed retainer with patients without retention appliance after treatment, and then compared the treated patients with untreated subjects.The overall aim of this thesis was to compare and evaluate two different mandibular fixed retainers and also to compare orthodontically treated cases with untreated long-term. This thesis is based on two studies and a PAR Index evaluation was presented in the frame story:Paper I is a retrospective longitudinal study done on dental casts and lateral head radiographs from patients who had received either a canine-to-canine retainer or a twistflex retainer after treatment. Different variables were measured, were Little’s Irregularity Index was the main outcome measure. The measurements were done at four different occasions, were the last registration was 12 years after treatment, i.e. 9 years after removal of retainer. Paper II is also a retrospective longitudinal study with three different groups, one group received a fixed mandibular retainer, one group did not receive any retention appliance after treatment and the third group was untreated subjects. Measurements were done on dental casts and lateral head radiographs at four different occasions to analyze dental and skeletal changes 12 years after treatment. Also here Little’s Irregularity Index was the main outcome measure. PAR Index evaluation is done to evaluate the stability of orthodontic treatment outcome after treatment and long-term for two different retainer groups and one non-retention group. The following conclusions were drawn: Paper I•Both the canine-to-canine retainer and the twistflex retainer can be recommended since both are equally effective during retention period.•None of the retention types prevent long-term changes of mandibular incisor irregularity or available space for the mandibular incisors after removal of the retainers.•No differences in bonding failures between the two retainers were found. Paper II•There were no differences found 12 years after treatment in Little’s Irregularity Index for the mandibular incisors between the group that had a retainer and the group that had no retainer after treatment•In the untreated group, Little’s Irregularity Index was increased over time but not to the same extent as in the treated groups. •The crowding before treatment did not explain the crowding at the last registration.•The use of mandibular retainers for two to three years does not appear to prevent long-term relapse. •If the patient wants to constrain the changes that come with natural development, then lifelong retention is needed.•The overjet and overbite were stable long-term.PAR Index evaluation•Twelve years after treatment the mean reduction in PAR score was over 70 per cent only for the groups who had a mandibular retainer after treatment. However, the non-retention group had a PAR score of 66 per cent.•There were more cases in the retention groups that were ”greatly improved and/or improved” 12 years after treatment compared to the non-retention group. After treatment between 16 and 23.3 per cent of all the cases were ”worse or not improved”. Twelve years after treatment between 36 and 43.6 per cent of the total cases were ”worse or not improved”.
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Chong, Boon Hor, and 鍾文一. "Risk of ischemic stroke and recurrent hemorrhagic stroke in Chinese population." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47323450.
Повний текст джерелаАнотація:
Stroke is a devastating, neurological dysfunction due to brain blood supply disturbance. It is responsible for increasingly high rate of mortality and disability worldwide. This thesis comprises two original studies involving 868 patients at risk of ischemic stroke and/or hemorrhagic stroke.
The first study investigated aspirin’s effect among patients with intracranial hemorrhage. Unlike Caucasians which hemorrhagic strokes account for 10-15% of all strokes; in Chinese, intracranial hemorrhages strike up to 35%. After such, anti-platelet agent like aspirin is often avoided for fear of recurrent intracranial hemorrhages, despite compelling indications. However, clinical data is limited. In this single-centered observational study, we included 440 consecutive Chinese patients with a first spontaneous intracranial hemorrhage surviving the first month performed during 1996-2010. 56 patients (12.7%) of these 440 patients were prescribed aspirin after intracranial hemorrhage (312 patient-aspirin years). After a mean follow-up of 62.2 ± 1.8 months, 47 patients had recurrent intracranial hemorrhage(10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have higher risk of recurrent intracranial hemorrhage compared with those without (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years and hypertension as independent predictors for recurrent intracranial hemorrhage. In a subgroup analysis: the incidence of combined vascular events including recurrent intracranial hemorrhage, ischemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than without (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). Implications of the results: despite having a substantial risk for recurrent intracranial hemorrhage, post-intracranial hemorrhage ones are at risk for thrombotic vascular events and management goal should thus focus on ameliorating overall cardiovascular risk instead of preventing recurrent intracranial hemorrhage. Hence, thrombo-prophylaxis should still be considered.
The second study investigated the relation between premature atrial complexes and new-onset atrial fibrillation together with other cardiovascular events. Premature atrial complexes though taken as benign phenomenon, are common in patients with underlying conditions such as coronary heart disease, chronic rheumatic heart disease. While prompt management of atrial fibrillation may prevent ischemic stroke, atrial fibrillation is often unfound until ischemic stroke occurs. In this study, 428 patients without atrial fibrillation but complained of palpitations, dizziness or syncope were recruited. 107 patients with >100 premature atrial complexes/day were defined to have frequent premature atrial complexes. After a mean follow-up of 6.1 ±1.3 years, 31 patients (29%) with frequent premature atrial complexes developed atrial fibrillation compared with 29 patients (9%) with premature atrial complexes?100/day (p<0.01). Cox regression analysis revealed: frequent premature atrial complexes, age>75 years and coronary artery disease were independent predictors. In secondary endpoint (ischemic stroke, congestive heart failure, and death), patients with frequent premature atrial complexes were more at risk than those without (34.5% vs. 19.3%) (Hazard ratio: 1.95, 95% confidence interval: 1.37-3.50, p=0.001). Cox regression analysis showed: age> 75 years, coronary artery disease and frequent premature atrial complexes were independent predictors. These permit early identification of high risks patients of new atrial fibrillation and other events, thus promoting appropriate preventive treatment.published_or_final_version
Medicine
Master
Master of Philosophy
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Abdirahman, Shire Wardhere. "Risk factors of recurrent acute obstructive bronchitis in children." Thesis, Sumy State University, 2014. http://essuir.sumdu.edu.ua/handle/123456789/36294.
Повний текст джерелаАнотація:
Broncho-obstructive syndrome (BOS) is the collective term including a symptom-complex of specifically outlined clinical implications of disturbance of bronchial passableness, having in the basis narrowing or an occlusion of respiratory tracts. Broncho-obstructive syndrome is condition, which is accompanied by recurrent attacks of expiratory dyspnea (difficulty to exhale) owing to the spasm of bronchial smooth muscles, edema of bronchi, and increased bronchial secretion.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/36294
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Olié, Valérie. "La maladie veineuse thromboembolique : étude des facteurs de risque de récidive." Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00719318.
Повний текст джерелаАнотація:
A partir des données de deux études de cohortes hospitalières françaises (MEVE etFARIVE), nous nous sommes intéressés aux facteurs de risque de récidive de maladieveineuse thromboembolique (MVTE).Nous avons confirmé un excès de risque de récidive de MVTE chez les hommescomparés aux femmes et montré que cette relation dépendait en partie de l'âge, de lamutation du FV Leiden et de la prise d'hormones au premier événement. Une analyse enfonction du sexe a mis en évidence que l'âge, l'obésité et des niveaux élevés de D-dimèresaugmentaient significativement le risque de récidive de MVTE chez les femmes. Par ailleurs,contrairement aux estrogènes oraux, les estrogènes transdermiques seuls ou combinés à laprogestérone micronisée n'exposaient pas les femmes ménopausées à un risque accru derécidive de MVTE. Chez les hommes, la mutation du facteur V Leiden, un antécédent familialde maladie artérielle et un premier événement idiopathique étaient des facteurs de risqueindépendants de récidive.L'identification de profils de risque différents en fonction du sexe pourrait permettreune meilleure stratification du risque de récidive de MVTE. Ces résultats devraientcontribuer à améliorer la prise en charge de la maladie par une évaluation individuelle de ladurée optimale du traitement anticoagulant. De plus, une bonne sécurité d'emploi desestrogènes transdermiques seuls ou combinés à la progestérone micronisée ouvre desperspectives cliniques intéressantes dans le traitement des troubles sévères de laménopause chez des patientes avec un antécédent personnel de MVTE.Mots