Patient Treatment Time Research Articles

An imperialist competition algorithm using a global search strategy for physical examination scheduling.

The outbreak of the novel coronavirus clearly highlights the importance of the need of effective physical examination scheduling. As treatment times for patients are uncertain, this remains a strongly NP-hard problem. Therefore, we introduce a complex flexible job shop scheduling model. In the process of physical examination for suspected patients, the physical examiner is considered a job, and the physical examination item and equipment correspond to an operation and a machine, respectively. We incorporate the processing time of the patient during the physical examination, the transportation time between equipment, and the setup time of the patient. A unique scheduling algorithm, called imperialist competition algorithm with global search strategy (ICA_GS) is developed for solving the physical examination scheduling problem. A local search strategy is embedded into ICA_GS for enhancing the searching behaviors, and a global search strategy is investigated to prevent falling into local optimality. Finally, the proposed algorithm is tested by simulating the execution of the physical examination scheduling processes, which verify that the proposed algorithm can better solve the physical examination scheduling problem.

Live well after stroke

Background: Difficulties in meeting guidelines on the intensity of therapy for acute stroke patients is common internationally. Current UK guidelines recommend patients receive a daily minimum of 45 minutes of each required therapy. This article details practice development work in an acute stroke unit in a large teaching hospital in Ireland, where an audit of stroke patients discharged in one month found that only 27% had received what is deemed ‘sufficient’ physiotherapy, while 30% had physiotherapy on fewer than half of their days of admission. Aim: Based on the audit, we looked at how we could increase therapy intensity for patients and correspondingly improve the quality of their experience of care and that of their therapists. We broadened our scope beyond physiotherapy to include occupational and speech and language therapies. We aimed to increase patient treatment time from an average baseline of eight to 16 minutes per day to 45 minutes per day. Methods: We used a combination of Lean Six Sigma and person-centred improvement principles, in conjunction with appreciative inquiry to redesign the current approach to therapy time. Results: Following our work, patient therapy time increased cumulatively by 125% across all therapies on days when no group classes were held and by 164% on days with classes. The average time patients spent with no therapy interaction outside therapy hours fell from 5.34 hours to 2.3 hours. Conclusions: The combination of approaches brought under the banner of the ‘Live Well After Stroke’ initiative ensured the project catalysed a new and more sustainable way of working together. The use of appreciative inquiry in our practice development workshops worked well as a way of respecting people’s sense of purpose and their values, and working with these to articulate, and progress towards, a desired shared future state. Implications for practice: Our use of the improvement sciences of Lean Six Sigma and person-centredness combined with appreciative inquiry demonstrates the synergistic elements of these sciences that can be optimised for use in practice development Without a change in resources, ways of providing therapy for this population can be redesigned to increase intensity Addressing culture as a key component of a practice development project resulted in an improvement in team collaboration and communication

The importance of organizational variables in treatment time for patients with ST-elevation acute myocardial infarction improve delays in STEMI

The time between arrival at the emergency department (ED) and balloon (D2B) in STEMI is one of the best indicators of the quality of care. Our aim is to describe treatment times and evaluate the causes of delay. This is an observational retrospective study, including all consecutive STEMI code patients ≥18 years old treated in the ED from 2013 to 2016.All the patients were stratified into two groups: delayed group with D2B>70min and non-delayed ≤70. The primary variable was D2B time. In total 327 patients were included, stratified according to their D2B as follows: 166 (67·48%) in the delayed group and 80 (32·52%) in the non-delayed group. The delayed group was older (p=0·005), with more females (p=0·060) and more atypical electrocardiogram (ECG) STEMI signs or symptoms (p=0·058) (p=0·087). Predictors of shorter D2B time were: typical STEMI ECG signs and short training sessions for nurses on identifying STEMI patients. There are delays particularly in specific groups with atypical clinical presentations. Short training sessions aimed at emergency nurses correlate with shorter delay. This suggests that continuing training for emergency nurses, along with organizational strategies, can contribute to increasing the quality of care. NCT04333381.

Dental age in children with impacted maxillary canines

Objective The aim of this study was to evaluate if delayed dental development is a cause of postponed care for patients with impacted maxillary canine (IMC). Materials and methods This case-control study was based on 403,355 children and adolescents in Region Västra Götaland, Sweden. The subjects, who were in the age range of 9–16 years during the period of 2011–2013, underwent surgical exposure or removal of a maxillary canine. Demirjian’s dental age assessment was carried out on panoramic radiographs. Results In total, 1028 patients, 514 with IMC and 514 age- and gender-matched controls, were enrolled. The patients with IMC exhibited a dental development delay of 0.2 years compared to the control group. In the impaction sub-groups, the female patients, patients in the chronological age group of 12–13 years, and patients with palatally positioned IMC had a significantly lower dental age than their paired-control subjects. Conclusions Overall, the difference in dental age between patients with or without IMC is significant but small, and as such is likely of minor clinical relevance. Therefore, the timing of preventive care and treatment for patients with IMC should be the same as that for patients with normally erupting canines.

Minimum Bladder Reference Contour To Guide Patient Setup For Prostate Radiotherapy

To evaluate if a model—based approach for bladder matching at the time of treatment reduces imaging and treatment time for prostate SBRT patients treated with a full bladder protocol. Prospectively collected data from prostate SBRT patients consecutively treated between 9/2019 and 1/2020 was used to select patients who experienced at least one treatment delay due to perceived underfilling of their bladder on CBCT. At our institution, a full bladder protocol (1 cup of water 45 min prior) checked by CBCT is employed for all treatments. When the pre-treatment bladder volume is smaller than the simulated volume, patients are asked to either wait longer and/or drink more water. A minimum bladder reference contour [min_bladder] was calculated for each patient by deforming the bladder contour at simulation [sim_bladder] with decreasing margins (1, 1.5, 2, 2.5, 3, 3.5, 4.5, and 5 cm) and identifying the smallest contour that met the bladder planning constraints (Maximum < 105%, V20Gy < 50% and V 36Gy < 10%). To evaluate the accuracy and efficacy of a model-based approach where min_bladder was used as the threshold for treatment initiation, the bladder on initial rejected CBCT was contoured, dose calculated and compared to min_bladder dose. Furthermore, treatment setup time reductions were estimated retrospectively as if the model had been used in the clinic. 64 patients were included in this study, of which 23 (36%) had delays due to perceived bladder underfilling (35/115 fractions). The average ± standard deviation sim_bladder and min_bladder size were 321 ± 117 and 134 ± 53 cm3, respectively. Comparing the min_bladder to the actual rejected setup bladder volume [rej_bladder] on CBCT predicted that the bladder would have been large enough for 22 fractions (63%) while for 13 fractions (37%) additional filling would have been necessary. When reviewing the doses to the rej_bladder, we found a model accuracy of 82%. For 3 fractions, the model predicted the volume was too small, but the rej_bladder met the dose constraints. For one patient, the rej_bladder shape did not conform well to the model and even though the rej_bladder was larger than the min_bladder, it did not meet the bladder constraints. The average total treatment times as recorded in Aria for fractions without delays versus those with delays was 28.1 ± 18 vs 49.6 ± 15 min (p<0.0001) (Student's t-test). Average estimated time that could be saved using the minimum bladder reference was 25± 11 min per fraction and number of CBCTs reduced from 2 to 1 per fraction. We found 36% of our prostate SBRT patients were delayed at least once during their treatment due to underfilling of their bladder. We demonstrate that employing a patient-specific model-based approach using a minimum bladder reference created at the time of planning could prevent treatment delays in the majority of cases and reduce the number of CBCTs used to setup patients for prostate SBRT.

Accountability Of Resources And Cost For Different Modalities

To evaluate feasibility in terms of cost for special treatment procedures across different modalities. An analysis of the cost of alternative state of the art treatment modalities was done to evaluate the necessity of more treatment options, compared to the financial gain provided by each. We used the 2019 Hospital Outpatient Prospective Payment System (HOPPS) to determine reimbursement for each treatment and assumptions on the time of physicist involvement, treatment planning, treatment time, time of radiation oncologist involvement (e.g. for gammaknife where the radiation oncologist stay during treatment), number of fractions per patient, average salaries and initial cost of modality and continuing cost of service contracts. We assumed one source exchange for gammaknife to extend its useful live. We did not include any existing overhead that will be the same between these modalities, rather just the cost of what is needed additionally for some modalities. We determined the maximum number of fractions that can be treated annually for each modality and the expected lifetime of each modality. We then calculated the number of patients needed annually to cover cost. For stereotactic radiosurgery modalities, i.e. CyberKnife, Linac-based, Linac/MRI, and gammaknife, the annual breakeven points were 25, 34, 41, and 74 patients respectively. For HDR the breakeven was 31 patients each year and 10 for a hyperthermia unit. For protons the number is higher with 152 patients. For each modality there is a limit on the number of patients that can be treated annually, depending on treatment time and common fractionations used for each modality. This favored Linac-based SRS and SBRT where the annual capacity was 1020 patients, because it was assumed that they are dedicated to stereotactic treatments, i.e. few fractions per patient and fastest treatment time. The annual capacity of patients treated with protons were 254, because of the assumption of 25 fractions per patient on average. For Gammaknife, CyberKnife, Linac/MRI, hyperthermia, and HDR the limits were 524, 331, 337, 104, and 433 respectively, because of long treatment times and/or planning times. Although hyperthermia needed the lowest number of patients to breakeven, its gain and limit on patient’s treated annually were the lowest because of a large need of physics and therapy time and relatively high service contracts. For large centers where there might be a larger number of patients that might benefit from a given modality, the cost can be reduced as staff gain more expertise to do these cases faster. Accountability for resources must be balanced by the number of patients that might benefit from it. Having more options of different modalities for state-of-the-art patient care might increase the potential number of patients and a center’s research potential, but it will also decrease the gain of each modality because of staff’s time, expertise, and service cost.

Evaluation of the effectiveness of treatment of patients with COVID-19 on the results of a laboratory study

The emergence of a new coronavirus infection was marked by the re-profiling of hospitals, including infectious diseases, to treat this category of patients. The accumulation of information about the effectiveness of its treatment is of scientific and practical interest. Purpose of the study : to evaluate the diagnosis and effectiveness of treatment of patients with COVID-19 Based on the results of laboratory tests. Materials and methods . The study was conducted in the period from 18.04.20 to 19.06.20, 379 patients were included in the study. Upon admission to the hospital, 27 patients had a positive nasal and pharyngeal swab by PCR for SARS-CoV-2 RNA, the results of MSCT of the OGC in 368 (99,5±0,38%) patients indicated the presence of pneumonia. On the first day of hospitalization, positive smears for SARS-CoV-2 RNA were in 172 (46,5±0,3%) patients, on the third day – in 96 (25,9±2,28%) patients. Patients with negative PCR results underwent enzyme immunoassay for IgM antibodies to SARS-CoV-2, in 108 (28,5±2,3%) they were found. Results. Upon admission to the hospital, a confirmed new coronavirus infection COVID-19 was observed only in 7,1±1,3%, in all the remaining 92,8±1,3% the diagnosis was probable. The majority of patients had MSCT results on admission. Novel coronavirus infection COVID-19 was not confirmed in 9,7±1,5% of hospitalized patients. All laboratory facilities were used for diagnostics. Confirmation of the disease based on the results of PCR diagnostics of nasal and nasopharyngeal swabs was achieved in 83,6±1,1%, and during the enzyme immunoassay for IgM antibodies to SARS-CoV-2 coronavirus – in 108 (28,5±2,3%) sick. The control X-ray examination of the chest organs showed positive dynamics in most patients (252; 71,6±2,4%). Some patients experienced the presence of the virus in the nose and nasopharynx after 12 days of treatment. Treatment times for smear-positive patients on days 10 and 12 were lengthened. The average number of days of inpatient treatment of patients with detected coronavirus infection with manifestations of pneumonia was 18±2,1 bed/days . Conclusion . In all patients who have a clinic of acute respiratory viral infection, it is necessary to diagnose a new coronavirus infection COVID-19 not only by PCR diagnostics, but also to use an enzyme-linked immunosorbent assay for SARS-CoV-2, with mandatory X-ray examination of the chest organs MSCT.

Lipoxin (LTX A4 5S, 6R, 15R) levels drastically decrease after 5 years of hemodialysis treatment.

The increased risk of atherosclerosis in patients with chronic kidney disease (CKD) is associated with the increased concentration of fatty acids from the omega-6 family. Products of arachidonic acid oxidation, including prostaglandins, thromboxanes, hydroxyleicosa-tetraenoic acids (HETES) and hydroxyoctadecadienoic acids (HODES) are involved in the pathogenesis of cancer and cardiovascular diseases due to increased oxidative stress. The aim of our study was to determine the relations resulting from the duration of CKD treatment. One of our main concerns is, whether and when the cascade of synthesis of inflammatory mediators may be insufficient in patients with CKD during many years of treatment. The study involved 121 patients with CKD and 87 healthy volunteers. Eicosanoid profiles 9(S)-HODE, 13(S)-HODE, 5(S)-HETE, 12(S)-HETE, 15(S)-HETE, 5(S)-oxoETE, 16(RS)-HETE, and 5(S),6(R)-lipoxinA4, 5(S),6(R),15(R)-lipoxinA4 were extracted in plasma. The HPLC separations were performed by means of 1260 liquid chromatography. Patients with CKD have a significantly higher concentration of the following inflammatory mediators: 13(S)-HODE, 5(S)-HETE, 12(S)-HETE, 15(S)-HETE, 5(S)-oxoETE, 16(RS)-HETE, and 5(S),6(R), 15(R)-lipoxinA4 relative to the control group. However, the concentrations of 9(S)-HODE were lower in the CKD group. The comparison of sexes did not show significant differences in terms of CKD. A tendency for lower concentrations of HETE and HODE were observed in the group of men. 15LOX, 12LOX and 5LOX pathways in chronic kidney disease are increased, while COX are suppressed (9-HODE). The analysis of the treatment time of patients with CKD shows that incorrect levels of 5(S), 6(R) and 15(R)-lipoxinA4 are developed. We present a new evidence of possible concepts and future clinical interventions in patients suffering from chronic kidney disease for many years. These data for the first time demonstrate that lipoxin levels drastically decrease in the course of CKD. Therefore, synthetic LXA4 analogues may be used as an antioxidant therapy in CKD, which requires further research.

Impact of comorbidities on clinical prognosis in 1280 patients with different types of COVID-19

The study aimed to compare the clinical characteristics and outcomes of patients with different types (ordinary, severe, and critical) of COVID-19. A total of 1280 patients diagnosed with COVID-19 were...

Epidemiology of Lateral Ankle Ligament Injury: Trends in Clinical Management and Likelihood of Progression to Surgical Intervention

Category:AnkleIntroduction/Purpose:Lateral ankle ligament sprains occur frequently in both general and athletic populations. Most patients recover from their injury without complication, however, some experience persistent pain and instability following lateral ankle injury, which requires treatment with surgical stabilization. The purpose of this study is to determine the utilization and associated costs of non-operative treatment modalities, such as physical therapy (PT), non-steroidal anti-inflammatory medication, and ankle bracing, as well the incidence of lateral ankle sprains that receive surgical treatment and the costs incurred by surgical treatment of chronic lateral ankle instability.Methods:Data was collected using the Pearl Diver Humana dataset using ICD-9, ICD-10, and CPT codes pertaining to ankle sprain, ankle ligament repair or reconstruction, physical therapy, ankle brace ordering, and non-steroidal anti-inflammatory medication (NSAID) ordering. Patients diagnosed with an ankle sprain were sub-divided into three categories: non-operative treatment, surgical ligament repair, and surgical ligament reconstruction. Incidence, cost, and PT usage was compared between patient groups. Cost analysis was performed per group using associated ICD/CPT cost and physical therapy cost. NSAID use and ankle bracing use was also examined.Results:Of patients who sustained lateral ankle injury, 64% were female and 36% were male. 306,180 (98.8%) patients successfully completed non-operative management. 2,774 (1.2%) patients underwent surgical intervention. 63,276 (20.7%) non- operative patients received physical therapy, whereas 1,536 (55.4%) surgically treated patients received PT after surgery. Only 725 (26.1%) surgical patients received pre-operative PT. Median time for total PT treatment of surgical patients was 21.8 weeks, while non-operative patients received treatment for a median time of 58.7 weeks. On average non-operative patients generated 11 billed days in PT while surgical patients received 8 days of PT before surgery and 11 days in PT after surgery. Average total cost per patient was $923.32 for non-operative patients, $3,384.63 for surgical ligament repair, and $3,659.98 for surgical ligament reconstruction.Conclusion:The vast majority of patients with lateral ankle ligament sprains do not progress to surgical treatment. Patients treated non-operatively used fewer physical therapy visits per patient and generated less cost compared to surgically treated patients. Only 20% of non-operative patients received physical therapy. Additionally, a higher proportion of surgically treated patients participated in PT compared to patients treated non-operatively.

Achieve Efficient and Privacy-Preserving Disease Risk Assessment Over Multi-Outsourced Vertical Datasets

It is believed that online disease risk assessment system has great potential to alleviate the medical treatment problems for the future smart city and communities, as it can excavate disease risk factors from a large number of patient features, provide diagnostic references for doctors, and save medical treatment time for patients. However, the flourish of online disease risk assessment service still faces severe challenges including information privacy and security. In this article, based on the naïve Bayesian classification, we propose an effi <underline xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">c</u> ient and priv <underline xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">a</u> cy-prese <underline xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">r</u> ving dis <underline xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">e</u> ase <underline xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">r</u> isk assessment scheme over multi-outsourced vertical datasets, named CARER. With CARER, the e-healthcare provider can securely train a disease risk predication model over vertically distributed medical data from multiple medical centers (i.e., hospitals), and provide privacy-preserving disease risk predication services for users (i.e., patients and doctors). During the model training and disease risk prediction phases, all sensitive data are operated over ciphertexts without decryption. As a result, the private information of medical centers, e-healthcare provider, and users can be well protected. Detailed security analysis shows that CARER can resist various known security threats. In addition, we evaluate the performance of CARER with real medical datasets, and the results demonstrate that CARER is efficient.

Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction.

ObjectiveTo explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China.MethodsWe retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF),the incidence of major adverse cardiovascular and cerebrovascular events (MACCE),Kaplan-Meier survival curves during the 28 days after the operation.ResultsThe times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05).ConclusionThe pre-hospital and in-hospital treatment times of STEMI patients during the COVID-19 epidemic were longer than those before the epidemic. Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis.

Effect of ethnicity and rurality on treatment delays in patients with colorectal cancer in Northland, New Zealand

Ethnic and rural disparities in medical treatment and outcomes have been demonstrated across a range of conditions, including colorectal cancer. Timely treatment and investigation of symptoms in patients with suspicion of cancer is likely to improve outcomes and patient experience. Achieving equity in timeliness of care is important in achieving the goal of equitable cancer outcomes outlined in the New Zealand cancer action plan. The aim of this study was to compare treatment times in patients with colorectal cancer, between Māori and non-Māori patients as well as urban and rural patients in Northland, New Zealand. All adult patients diagnosed with colorectal adenocarcinoma from 2011 to 2016 were identified using hospital coding. Further information on the primary cohort was then obtained using the hospitals electronic results system, CONCERTO. The primary outcomes of interest were differences in delays to treatment between Māori and non-Māori as well as Urban versus rural residence. Secondary outcomes of interest included rate of emergency admission and treatment by curative intent in different groups. A total of 511 patients formed the primary cohort; 12% were Māori and were on average 6 years younger than non-Māori. Māori had a 6% higher emergency admission rate and a 5% higher rate of palliative treatment intent. No significant difference in treatment delay times was seen between different ethnicities or different domiciles. Ethnicity and rurality were not shown to affect treatment delays. Further research in this area is needed to help attain equitable outcomes for patients with colorectal cancer in New Zealand.

Noninvasive treatment of pectus excavatum with a vacuum bell combined with a three-dimensional scanner

Our aim was to evaluate the effect of a vacuum bell (VB) combined with a three-dimensional (3D) scanner for the noninvasive treatment of pectus excavatum (PE). A VB was used to create a vacuum at the anterior chest wall with a patient-activated hand pump, and it should be applied regularly for more than 2h each day at home. Eighty-two patients required to be followed up every three months were included in this retrospective study and distributed into four stages (stage 1: treated for 3months, stage 2: treated for 6months, stage 3: treated for 9months, and stage 4: treated for 12months). In addition, the deformity in the chest wall was scanned by a 3D scanner at the clinic, and the 3D depth (3D-DE) and 3D Haller index (3D-HI) of PE were calculated through Geomagic studio 2013 software. Eighty-two patients (12/2017-12/2019) met the criteria at the clinic, and 24 patients (29.3%) achieved excellent correction (3D-DE ≤ 3mm). When comparing the improvement in 3D-DE and 3D-HI of PE to the patient's treatment time, a statistically significant difference was observed between stages 2 and 1 (3D-DE p<0.01, 3D-HI p<0.01), stages 3 and 2 (3D-DE p<0.01, 3D-HI p<0.01) and stages 4 and 3 (3D-DE p<0.01, 3D-HI p<0.01). There was a statistically significant difference in sternum elevation between patients aged <10years and those aged ≥ 10years (3D-DE p = 0.006, 3D-HI p = 0.045) and patients with symmetrical and asymmetric PE (3D-DE p = 0.042, 3D-HI p = 0.032). However, there was no statistically significant difference in sternal elevation between males and females (3D-DE p = 0.27, 3D-HI p = 0.495). The main side effects were moderate subcutaneous hematoma, petechial bleeding, thoracalgia and chest tightness. With controllable side effects, noninvasive treatment for PE with a VB combined with a 3D scanner is safe, objective and radiation free, and the initial results to date are encouraging. Patients aged <10years, with symmetrical PE and treated for over 12months may achieve a better outcome.

Design of a Virtual Environment Applied to Social Phobias to reduce the Treatment time in Patients

Design of a Virtual Environment Applied to Social Phobias to reduce the Treatment time in Patients

COVID-19: digital equivalence of health care in English prisons

COVID-19: digital equivalence of health care in English prisons

Open-label multicenter registry on the outcomes of peripheral arterial disease treated by balloon angioplasty with optical frequency domain imaging in superficial femoral artery and popliteal artery (OCEAN-SFA study).

Although balloon angioplasty for femoropopliteal artery lesions has been associated with restenosis rates of up to 60% at 12months, the mechanism of restenosis has not been fully evaluated. The aim of this study was to evaluate the relationship between the vascular features observed on optical frequency domain imaging (OFDI) before and after balloon angioplasty of femoropopliteal artery lesions, and restenosis at 6months. This study was a prospective multicenter single arm study. OFDI was performed before and after balloon angioplasty and plaque characteristics and vascular features, along with de novo lesions, were assessed. The primary outcome was the presence or absence of restenosis 6months after balloon angioplasty. Residual platelet reactivity was assessed according to VerifyNow platelet reactivity units (PRUs). The number of patients completing 6months of follow-up was 47, of which 14 had developed restenosis. Maximum thickness of the dissection flap (odds ratio (OR) 2.71; 95% confidence interval [0.9-8.0]; p = 0.071) and lesion length were identified as risk factors for restenosis (OR 1.015; 95% confidence interval [0.001-0.029]; p = 0.039). The mean PRU at the time of treatment in patients with restenosis was significantly higher than in those without restenosis (286.3 ± 82.6 vs. 208.5 ± 03.6, p = 0.026). Long lesions and major dissection on OFDI after balloon angioplasty for femoropopliteal artery lesions increase restenosis at 6months. In addition, high residual platelet reactivity at the time of EVT may also be a risk factor for restenosis.Clinical Trial Registration Number UMIN000021120.

Impact of proton radiotherapy on treatment timing in pediatric and adult patients with CNS tumors.

Despite putative benefits associated with proton radiotherapy in the setting of CNS tumors, numerous barriers limit treatment accessibility. Given these challenges, we explored the association of proton use with variations in treatment timing. Pediatric and adult patients with histologically confirmed CNS tumors were identified from the National Cancer Database (2004-2015). Univariable and multivariable regression models were constructed to assess factors impacting radiation timing. Multivariable Cox regression was used to evaluate the effect of treatment delay on survival. A total of 76 157 patients received photon or proton radiotherapy. Compared to photons, time to proton administration was longer in multiple pediatric (embryonal, ependymal, nonependymal glial, and other) and adult (ependymal, nonependymal glial, meningeal, other) tumor histologies. On adjusted analysis, proton radiotherapy was associated with longer delays in radiotherapy administration in pediatric embryonal tumors (+3.00 weeks, P = .024) and in all adult tumors (embryonal [+1.36 weeks, P = .018], ependymal [+3.15 weeks, P < .001], germ cell [+2.65 weeks, P = .024], glial [+2.15 weeks, P < .001], meningeal [+5.05 weeks, P < .001], and other [+3.06 weeks, P < .001]). In patients with high-risk tumors receiving protons, delays in adjuvant radiotherapy were independently associated with poorer survival (continuous [weeks], adjusted hazard ratio = 1.09, 95% CI = 1.02-1.16). Proton radiotherapy is associated with later radiation initiation in pediatric and adult patients with CNS tumors. In patients with high-risk CNS malignancies receiving protons, delayed adjuvant radiotherapy is associated with poorer survival. Further studies are needed to understand this discrepancy to maximize the potential of proton radiotherapy for CNS malignancies.

Relationship between the polymorphism in the interleukin 1-β and the treatment time of patients subjected to a modified piezocision technique.

Aim: We aimed to evaluate the correlation between the polymorphism of the interleukin 1-Beta (IL1-β, +3954 C>T) and tooth movement, in a group of Colombian patients undergoing surgically accelerated orthodontic tooth movement. Methods: The study was nested to a controlled clinical trial. Blood samples were taken from 11 women and 29 healthy Colombian male volunteers between 18 and 40 years old, after 1 year of starting orthodontic treatment. The patients presented malocclusion class I, with grade II or III. To detect the genetic polymorphism of the nucleotide +3954 C to T in the IL-1β gene, we used a real-time PCR assay. Results: Eleven individuals presented the allele 2 (T) heterozygous with the allele 1 (T/C) and 19 individuals were homozygous for the allele 1 (C/C). When analyzing the presence of the SNP, no significant differences were found in any of the variables. The best treatment was reflected in Group 3 (selective upper and lower alveolar decortication and 3D collagen matrix) and Group 4 (only selective alveolar decortication in the upper arch, with 3D collagen matrix), with 27% and 35% more speed respectively than in the control group. Conclusions: Our analyses indicated that a reduction in the total treatment time can be mostly potentiated by using decortication and collagen matrices and not for the presence of the allele 2 in the IL-1β. Nevertheless, it is important that further studies investigate if the polymorphism could be associated with the speed of tooth movement and analyze the baseline protein levels.

Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study

Abstract Background This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus (HIV) patients in whom antiretroviral therapy (ART) was unsuccessful. Methods In this retrospective study, a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1 (treatment time ≤3 years, n1 = 5,218) and Group 2 (treatment time > 3 years, n2 = 4,200). Patient follow-up data, including age, cluster of differentiation 4 (CD4) count, and viral load, glucose, creatinine, and triglyceride levels, were extracted from electronic health record databases. Covariance analysis for repeated measures was used to analyze the biochemical indicators, and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time. Results The median initial CD4 count was 175.0 cells/μl (interquartile range, 77.0–282.0), while the initial CD4 counts for Group 1 were lower than those for Group 2 (P Conclusion The initial biochemical parameters can affect the survival and treatment time of HIV patients. With a comprehensive understanding of the physiological and biochemical indicators of patients, we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.