| 1. |
- Taddei, C, et al.
(författare)
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Repositioning of the global epicentre of non-optimal cholesterol
- 2020
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 582:7810, s. 73-
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Tidskriftsartikel (refereegranskat)abstract
- High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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| 2. |
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| 3. |
- Alnadhari, Ibrahim, et al.
(författare)
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Presentation, diagnosis, management, and outcomes of prostatic abscess : comparison of three treatment modalities
- 2020
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Ingår i: Therapeutic advances in urology. - : Sage Publications. - 1756-2872 .- 1756-2880. ; 12, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.Methods:We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.Results:A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.Conclusion:Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.
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| 4. |
- Moraes, Ana Luiza Dallora, et al.
(författare)
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Chronological Age Assessment in Young Individuals Using Bone Age Assessment Staging and Nonradiological Aspects : Machine Learning Multifactorial Approach
- 2020
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Ingår i: JMIR Medical Informatics. - : JMIR Publications. - 2291-9694. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bone age assessment (BAA) is used in numerous pediatric clinical settings, as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical since the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods suffer from drawbacks such as exposure of minors to radiation, do not consider factors that might affect the bone age and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA.Objective: This paper aims to investigate CA estimation through BAA in young individuals of 14 to 21 years with machine learning methods, addressing the drawbacks in the research using magnetic resonance imaging (MRI), assessment of multiple ROIs and other factors that may affect the bone age.Methods: MRI examinations of the radius, distal tibia, proximal tibia, distal femur and calcaneus were carried out on 465 males and 473 females subjects (14-21 years). Measures of weight and height were taken from the subjects and a questionnaire was given for additional information (self-assessed Tanner Scale, physical activity level, parents' origin, type of residence during upbringing). Two pediatric radiologists assessed, independently, the MRI images as to their stage of bone development (blinded to age, gender and each other). All the gathered information was used in training machine learning models for chronological age estimation and minor versus adults classification (threshold of 18 years). Different machine learning methods were investigated.Results: The minor versus adults classification produced accuracies of 90% and 84%, for male and female subjects, respectively, with high recalls for the classification of minors. The chronological age estimation for the eight age groups (14-21 years) achieved mean absolute errors of 0.95 years and 1.24 years for male and female subjects, respectively. However, for the latter lower error occurred only for the ages of 14 and 15.Conclusions: This paper proposed to investigate the CA estimation through BAA using machine learning methods in two ways: minor versus adults classification and CA estimation in eight age groups (14-21 years), while addressing the drawbacks in the research on BAA. The first achieved good results, however, for the second case BAA showed not precise enough for the classification.
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| 5. |
- Trindade, Fábio, et al.
(författare)
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Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy
- 2020
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Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 15:9
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Tidskriftsartikel (refereegranskat)abstract
- Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.
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| 6. |
- Toffaha, Ali, et al.
(författare)
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What you see might not be what you get : Discrepancies between intraoperative findings and preoperative diagnosis of ovarian tumors. Appendicular mucocele presenting as an adnexal mass - Case report and review of literature
- 2020
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Ingår i: International Journal of Surgery Case Reports. - : Elsevier. - 2210-2612. ; 75, s. 543-549
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Adnexal masses include those affecting the ovary or fallopian tubes. We report a unique case with discrepancy between the pre-operative diagnosis (adnexal mass) and the post-operative definitive findings (appendicular tumor invading ovary). We also employ a literature review to provide four scenarios of uncertainty that are encountered between appendiceal and adnexal masses. Presentation of case: A 58 year old female with history of treated left colon cancer, referred to the gynecology clinic with intermittent vaginal bleeding for 5 days. Examination showed lower abdominal midline mobile non-tender mass, bulky uterus and right adnexal fullness. Other history, physical examination and laboratory tests were unremarkable. US and MRI suggested a right ovarian mass and uterine fibroids. Intraoperatively, she had a right ovarian large mobile multi-locular mass. The appendix was adherent to the ovary, with mucus extruding through its tip. Appendectomy was undertaken alongside hysterectomy and bilateral salpingo-oophorectomy. Histopathology showed right ovarian mucinous neoplasm, but the origin was a low-grade appendiceal mucinous neoplasm (pT4aNxMx). The patient was recurrence free across 3 years of follow up. Discussion: Appendicular mucocele can present as adnexal mass. Pre-operative diagnosis and differentiation is sometimes difficult. Conclusion: Adnexal masses need careful pre-operative diagnoses. The definitive management is based on the final intra- and post-operative findings. As a variety of scenarios could be encountered, there could be a need to involve general/colorectal surgeons in case of appendicular tumors. Patients should be counselled regarding the possible change in intra-operative plan, and are better operated upon in facilities with appropriate teams and equipment.
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| 7. |
- Rexhepi, Hanife, 1984-, et al.
(författare)
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Online electronic healthcare records : Comparing the views of cancer patients and others
- 2020
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 26:4, s. 2915-2929
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates differences in attitudes towards, and experiences with, online electronic health records between cancer patients and patients with other conditions, highlighting what is characteristic to cancer patients. A national patient survey on online access to electronic health records was conducted, where cancer patients were compared with all other respondents. Overall, 2587 patients completed the survey (response rate 0.61%). A total of 347 respondents (13.4%) indicated that they suffered from cancer. Results showed that cancer patients are less likely than other patients to use online electronic health records due to general interest (p < 0.001), but more likely for getting an overview of their health history (p = 0.001) and to prepare for visits (p < 0.001). Moreover, cancer patients rate benefits of accessing their electronic health records online higher than other patients and see larger positive effects regarding improved communication with and involvement in healthcare.
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| 8. |
- Al Zoubi, Mohammad, et al.
(författare)
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Largest case series of giant gallstones ever reported, and review of the literature
- 2020
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Ingår i: International Journal of Surgery Case Reports. - : Elsevier. - 2210-2612. ; 72, s. 454-459
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of cases: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. Conclusions: Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties. © 2020 The Author(s)
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| 9. |
- Behnsen, Pia, et al.
(författare)
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Heart rate (variability) and the association between relational peer victimization and internalizing symptoms in elementary school children
- 2020
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Ingår i: Development and psychopathology (Print). - : Cambridge University Press. - 0954-5794 .- 1469-2198. ; 32:2, s. 521-529
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Tidskriftsartikel (refereegranskat)abstract
- Relational victimization typically emerges first during the elementary school period, and has been associated with increased levels of internalizing symptoms in children. Individual differences in autonomic nervous system functioning have been suggested as a potential factor linking social stressors and internalizing symptoms. The aim of this study was therefore to examine whether heart rate and heart rate variability mediated the association between relational victimization and internalizing symptoms in 373 mainstream elementary school children. Children were assessed in 2015 (T 0 ; Grades 3-5, M age = 9.78 years, 51% boys) and reassessed in 2016 (T 1 ). Heart rate and heart rate variability were assessed during a regular school day at T 1 . A multi-informant (teacher and peer report) cross-time measure of relational victimization, and a multi-informant (self- and teacher report) measure of internalizing problems at T 1 was used. Results showed that heart rate variability, but not heart rate, mediated the association between relational victimization and internalizing symptoms. This study provides tentative support that in children from a general population sample, a psychobiological factor may mediate the association of relational victimization with internalizing symptoms.
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| 10. |
- Carlén, Kristina, et al.
(författare)
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Sense of coherence predicts adolescent mental health
- 2020
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 274, s. 1206-1210
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Tidskriftsartikel (refereegranskat)abstract
- Background: Strong sense of coherence (SOC) has been shown to predict good mental health among adults whereas its predictive value in adolescence is unclear. This life-course oriented prospective study explores whether SOC predicts mental health in a three-year follow-up. Methods: The data is part of the ongoing ‘Finnish Family Competence Study’ launched in 1986 in southwestern Finland (baseline n = 1287). The outcome variable was adolescent's mental health at 18 years of age, measured on the Development and Well-Being Assessment (DAWBA) scale. The main predictor was Antonovsky's SOC score (1987) measured at the age of 15. A total of 498 adolescents were included in the present analyses. Poisson regression was used by univariate and multivariable models using the parents’ age and socioeconomic status and adolescents’ gender as covariates. Results: Multivariable analysis showed that a one-unit increase in SOC decreased the relative risk of a DAWBA-based diagnosis by 4 % (RR [95% CI] 0.96 [0.94–0.98], p < 0.001). Limitations: Typical of very long follow-up, as in our study of nearly two decades, a substantial proportion of the original population-based cohort was lost to follow-up weakening the representability of our cohort. Conclusions: Sense of coherence is a useful and clinically sensitive tool to predict mental health in adolescence. The easily administered, coping-oriented SOC questionnaire is an appropriate instrument in screening for adolescents who would benefit from supportive measures to strengthen their mental well-being.
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