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Syed Faraz Kazim,Alis J. Dicpinigaitis,Christian A. Bowers,Smit Shah,William T. Couldwell,Rachel Thommen,Daniel J. Alvarez-Crespo,Matthew Conlon,Omar H. Tarawneh,John Vellek,Kyril L. Cole,Jose F. Domi 대한척추신경외과학회 2022 Neurospine Vol.19 No.1
Objective: The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry. Methods: The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5. Results: Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality. Conclusion: Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.
Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus
Alptug Tokatli,Fethi Kiliçaslan,Metin Alis,Omer Yiginer,Mehmet Uzun 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.1
Background: Type 2 diabetes mellitus (T2DM) is associated with increased risk of malignant ventricular arrhythmias. Cardiac electrical inhomogeneity may be the leading cause of the increased arrhythmic risk in patients with T2DM. The peak and the end of the T wave (Tp-e) interval and associated Tp-e/QT ratio are promising measures of ventricular repolarization indicating transmural dispersion of repolarization. The aim of this study was to assess ventricular repolarization in patients with T2DM by using Tp-e interval, Tp-e/QT ratio and Tp-e/corrected QT interval (QTc) ratio. Methods: Forty-three patients with T2DM and 43 healthy control subjects, matched by gender and age, were studied. All participants underwent electrocardiography (ECG) recording. PR, RR and QT intervals represents the ECG intervals. These are not abbreviations. In all literature these ECG intervals are written like in this text. Tp-e intervals were measured from 12-lead ECG. Rate QTc was calculated by using the Bazett’s formula. Tp-e/QT ratio and Tp-e/QTc ratio were also calculated. Results: Mean Tp-e interval was significantly prolonged in patients with T2DM compared to controls (79.4± 10.3, 66.4± 8.1 ms, respectively; P<0.001). We also found significantly higher values of Tp-e/QT ratio and Tp-e/QTc ratio in patients with diabetes than controls (0.21± 0.03, 0.17± 0.02 and 0.19± 0.02, 0.16± 0.02, respectively; P<0.001). There was no difference in terms of the other ECG parameters between the groups. Conclusion: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were prolonged in patients with T2DM. We concluded that T2DM leads to augmentation of transmural dispersion of repolarization suggesting increased risk for ventricular arrhythmogenesis.
Matthew Conlon,Rachel Thommen,Syed Faraz Kazim,Alis J. Dicpinigaitis,Meic H. Schmidt,Rohini G. McKee,Christian A. Bowers 대한척추신경외과학회 2022 Neurospine Vol.19 No.4
Objective: To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs). Methods: The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes. Results: Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/ C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001). Conclusion: Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAIbased frailty indices can be used in preoperative risk assessment of spinal trauma patients.
Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation
Süleyman Büyükaşık,Mehmet Abdussamet Bozkurt,Selin Kapan,Halil Alis 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.5
Purpose: Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.Methods: Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.Results: The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).Conclusion: We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.
Validity and Reliability of the Turkish Version of Generalized Anxiety Disorder Scale-Revised
Anıl Gü,ndü,z,Ibrahim Gü,ndog˘mus,Sencan Sertç,elik,Betü,l Hacer Engin,Aysel I s¸ler,Alis¸an Burak Yas¸ar,Hatice Gö,nü,l,Arif Ç,ipil,Elvan Bas¸ak Usta Gü,ndü,z 대한신경정신의학회 2021 PSYCHIATRY INVESTIGATION Vol.18 No.10
Objective This study aims to assess the psychometric values of the Generalized Anxiety Disorder Scale-Revised (GADS-R) which measures the intensity and duration of worry, various coping and avoidance strategies to cope with worrying, and positive and negative metacognitive beliefs about worrying. Methods 114 patients with generalized anxiety disorder and 198 healthy controls were included in the study. These patients were diagnosed according to DSM-IV TR, and the primary diagnosis of the patients was generalized anxiety disorder which was confirmed via SCID I and II, subsequently. Sociodemographic form, GADS-R total and subscale scores, and Meta-Cognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Generalized Anxiety Disorder-7 Scale (GAD-7), and Penn State Worry Questionnaire (PSWQ) were used to assess validity, reliability and cut-off point. Results GADS-R total and subscale scores and MCQ-30, BDI, BAI, GAD-7, and PSWQ were found to be statistically higher in the patients with GAD compared to a healthy control group. GADS-R has five factors and showed relatively acceptable sensitivity and specificity for detecting anxiety disorders at a cut-off point of 1188. Conclusion The GADS-R is a valid and reliable scale that can be used in the Turkish population as an assessment tool.