Medicine
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Comparative Study
Left atrial function as assessed by speckle-tracking echocardiography in hypertension.
We investigated left atrial (LA) function in relation to hypertension using 2-dimensional speckle-tracking echocardiography (STE) in subjects with preserved left ventricular (LV) ejection fraction, while accounting for LA enlargement and LV mass and diastolic function. We performed standard 2-dimensional and Doppler echocardiography and LA volumetric measurements and STE strain imaging in hypertensive patients (systolic/diastolic blood pressure ≥140/90 mmHg, or use of antihypertensive drugs, n = 124) and age- and sex-matched normotensive subjects (n = 124). We measured the peak LA velocity, strain, and strain rate during systole and early and late diastole, respectively. ⋯ Hypertensive patients also had impaired LA function, as measured by STE velocity, strain, and strain rate in general and in the absence of LA enlargement (P < 0.0001). The differences in LA STE strain rate during LV systole and LA contraction between hypertension and normotension in the absence of LA enlargement remained statistically significant (P < 0.001), after adjustment for age, sex, and LV mass index and E/E'. Hypertension is associated with impaired LA function, as assessed by STE strain imaging technique, even before LA enlargement develops and after LV remodeling is accounted for.
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Observational Study
Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence.
Recurrence of acute diverticulitis is common, and--especially complicated recurrence--causes significant morbidity. To prevent recurrence, selected patients have been offered prophylactic sigmoid resection. However, as there is no tool to predict whose diverticulitis will recur and, in particular, who will have complicated recurrence, the indications for sigmoid resections have been variable. ⋯ Low-risk and high-risk groups had 3% and 43% 5-year complicated recurrence rates, respectively. Risk for complicated recurrence of acute diverticulitis can be assessed using risk scoring. The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.
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Observational Study
The predictive accuracy of PREDICT: a personalized decision-making tool for Southeast Asian women with breast cancer.
Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. ⋯ The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy. PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings.
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Our previous study indicated overexpression of metadherin (MTDH) is an adverse prognostic factor in squamous cell carcinoma of the head and neck (SCCHN) and promotes SCCHN cell proliferation and invasion. However, its mechanism remains unclear. Recent studies have indicated that MTDH is a cancer-metastasis-associated molecule that participates in the process of angiogenesis. ⋯ In addition, inhibition of the Akt signaling pathway reversed the upregulation of VEGF resulting from MTDH overexpression. Moreover, the survival analysis revealed that VEGF is an independent prognostic factor, and a combined survival analysis based on both MTDH and VEGF showed synergistic effects in the prognosis evaluation of SCCHN patients. The findings of the present study demonstrate that MTDH regulates the expression of VEGF via the PI3K/Akt signaling pathway, indicating the potential role of the MTDH-mediated activation of VEGF signaling pathway in SCCHN angiogenesis and metastasis.
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East Asian patients with diabetes have a higher risk for renal complications and strokes than Europeans. We aimed to evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) gene 677 C → T polymorphism, which was associated with a higher stroke risk and was common in the Chinese population, as well as homocysteine and estimated glomerular filtration rate (eGFR) levels on the risk of new-onset diabetes (NOD). A total of 2422 subjects without diabetes were followed-up for 7 years. ⋯ Females with MTHFR 677 TT genotype had a significantly higher risk of NOD, particularly those with higher BMI or low HDL-C levels. The higher risk of NOD associated with mildly decreased eGFR also warrants more investigation. Our results provide insights into the ethnic differences of diabetic complications between East Asian patients and Europeans.