No / To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. MATERIALS AND METHODS: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6-8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren-Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. RESULTS: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55-9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6-8 weeks post-injection. No associated complications were observed. CONCLUSION: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

In der Behandlung der zervikalen Dystonie wird die Therapie mit Botulinumtoxin (BTX) erfolgreich angewendet. Neben dieser Therapie werden von Patienten oft alternative Therapien (CAM [Complementary and Alternative Medicine]) angesprochen und ausprobiert. Diese Studie geht der Frage nach, wie häufig CAM-Therapien genutzt werden, wie deren Wirkung bewertet wird und ob es Prädiktoren für die Therapiewahl gibt. Zur Datenerhebung wurden 265 Fragebögen von zwei Patientengruppen ausgewertet. Gruppe 1 (n=101) bestand aus Patienten der Botulinumtoxinsprechstunde des Universitätsklinikums Leipzig und der Paracelsus Klinik Zwickau. Gruppe 2 (n=165) wurde aus Mitgliedern des Selbsthilfeverbandes Bundesverband-Torticollis e.V. rekrutiert. Bei 86% der Patienten wurde die Therapie mit BTX angewendet. Von den Therapiemöglichkeiten der CAM wurden am häufigsten physikalische Therapien (Massagen n=171) genannt. Am besten bewertet wurden jedoch, neben der BTX-Therapie, spezielle physiotherapeutische sowie psychotherapeutische Verfahren. Die CAM-Therapien wurden häufig in Kombination mit der BTX-Therapie angewendet und von Patienten, deren Erkrankung einen langen chronischen Verlauf vorwies (>10 Jahre). Als Prädiktoren für die Wahl einer CAM-Therapie zeigten sich eine Zugehörigkeit zur Gruppe 2, aufgetretene Nebenwirkungen im Rahmen der BTX-Therapie, männliches Geschlecht und erhöhter Stress bei den Erkrankten. Außerdem fand sich ein signifikanter Unterschied zu einem höheren Bildungsabschnitt und Arbeit in gehobeneren Berufsgruppen bei Patienten, die vermehrt CAM Therapie anwenden. Zusammenfassend wurden CAM-Therapien, neben der Behandlung mit BTX, häufig von den Befragten angewendet. Hohe Zufriedenheitswerte erzielte eine Kombination mit physiotherapeutischen Verfahren oder Psychotherapie. Die Wahl von CAM-Therapien ist von der Erkrankungsdauer, Bildungslage und finanziellen Ressourcen abhängig.

The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling &#8211; total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour. / Psychology / M.Soc.Sc.

AQ4N (banoxantrone) is a prodrug that, under hypoxic conditions, is enzymatically converted to a cytotoxic DNA-binding agent, AQ4. Incorporation of AQ4N into conventional chemoradiation protocols therefore targets both oxygenated and hypoxic regions of tumors, and potentially will increase the effectiveness of therapy. This current pharmacodynamic and efficacy study was designed to quantify tumor exposure to AQ4 following treatment with AQ4N, and to relate exposure to outcome of treatment. A single dose of 60 mg/kg AQ4N enhanced the response of RT112 (bladder) and Calu-6 (lung) xenografts to treatment with cisplatin and radiation therapy. AQ4N was also given to separate cohorts of tumor-bearing mice 24 hours before tumor excision for subsequent analysis of metabolite levels. AQ4 was detected by high performance liquid chromatography/mass spectrometry in all treated samples of RT112 and Calu-6 tumors at mean concentrations of 0.23 and 1.07 microg/g, respectively. These concentrations are comparable with those shown to be cytotoxic in vitro. AQ4-related nuclear fluorescence was observed in all treated tumors by confocal microscopy, which correlated with the high performance liquid chromatography/mass spectrometry data. The presence of the hypoxic marker Glut-1 was shown by immunohistochemistry in both Calu-6 tumors and RT112 tumors, and colocalization of AQ4 fluorescence and Glut-1 staining strongly suggested that AQ4N was activated in these putatively hypoxic areas. This is the first demonstration that AQ4N will increase the efficacy of chemoradiotherapy in preclinical models; the intratumoral levels of AQ4 found in this study are comparable with tumor AQ4 levels found in a recent phase I clinical study, which suggests that these levels could be potentially therapeutic.

<p>Ciljevi: Cilj ove studije je da ispita bezbednost rane karotidne endarterektomije (CEA) u odnosu na odložene CEA nakon akutnog ishemijskog neurolo&scaron;kog deficita (TIA/CVI). Drugi cilj je da istražimo da li postoji razlika u brzini neurolo&scaron;kog oporavka između navedenih grupa. Metode: Ukupno 157 ispitanika u prospektivnoj studiji je praćeno 30 dana postoperativno. Grupa I ili rana CEA, je imala 50 ispitanika operisanih od 3. do 14. dana po TIA/CVI događaju. Grupa II ili odložena CEA, je imala 107 ispitanika operisanih od 15. do 180. dana nakon TIA/CVI. Praćen je proceduralni op&scaron;ti i specifični morbiditet i mortalitet u 30-dnevnom postoperativnom periodu. Rankin skor (mRS) smo koristili za procenu neurolo&scaron;kog invaliditeta. U odnosu na vrednost mRS skora smo formirali dve podgrupe mRS&lt;3 i mRS3. U statističkoj analizi koristili smo Pirsonov hi test, Studentov test, ANOVU analizu varijanse, Boniferonijev test i multiplu analizu varijanse za ponovljena merenja (GLM- general line model), kao i parametarsku i neparametarsku korelaciju i regresiju. Nivo značajnosti je bio 0,05. Rezultati: Prosečna starost ispitanika je bila 66,72 godine uz 66,2% osoba mu&scaron;kog pola. U grupi I je prosečno vreme do intervencije bilo 9,5 dana, a u grupi II 72,22 dana. Grupe su homogene u odnosu na faktore rizika i komorbiditet. Grupa I je imala 54% nestabilnih aterosklerotskih plakova u poređenju sa grupom II gde ih je bilo 31,8% (&chi;2 = 7.084; p &lt; 0.01). U grupi I TIA je imalo 50% ispitanika, a u grupi II CVI nalaza je bilo 68,2% (&chi;2 =4.825; p &lt;0.05). CVI do 1 cm veličine je statistički značajno vi&scaron;e zastupljen u grupi I , a CVI do 2 cm u grupi II (&chi;2 = 6.913; p &lt;0.05). Stopa CVI je u grupi I bila 2.0% a u grupi II je 2.8% (F = 0.083; p &gt; 0.05). Stopa postoperativnog infarkta miokarda (IM) je u grupi I je 2.0% a u grupi II je 1.9%. Stopa specifičnog hirur&scaron;kog morbiditeta je u grupi I 4.0% a u grupi II 3.7%. U grupi I ukupni morbiditet bio 6.0% a u grupi II 7.5%, razlika nije bila statistički značajna (F =0.921; p &gt; 0.05). Mortaliteta u obe grupe nije bilo. CVI/IM/smrt stopa je u grupi I bio 4.0% a u grupi II je bio 4.7% (F = 0.122; p &gt;0.05). Hiperlipidemija je signifikantan faktor rizika za CVI/IM/smrt (&chi;2 = 4.083; p &lt; 0.05). Pobolj&scaron;anje mRS je u grupi I imalo 52%, a u grupi II 31,8% pacijenata (&chi;2 = 5.903; p &lt;0.01). Relativni rizik je 2,4 odnosno toliko puta je veća &scaron;ansa da kod bolesnika dođe do promene mRS ako je bolesnik u grupi I. Pad mRS koji nastupa između trećeg i desetog dana nakon CEA je statistički visoko značajno izraženiji u grupi ranih CEA ( F 3,701 df 1 p=0,029). Kod bolesnika sa TIA u preko 60% slučajeva do&scaron;lo je do pada mRS, a kod onih koji su imali CVI u oko 25.5% (&chi;2 = 18.050; p &lt; 0.01). Kod Rankin skora podgrupe mRS&lt;3 i mRS3 je pad bio značajan i po vremenu (F 18,774; df 6; p=0,000) i po podgrupi ali je daleko brži pad zapažen u podgrupi mRS&lt;3(F 6,010; df 1; p=0,003). Zaključak: Rana CEA je jednako bezbedna kao i odložena CEA u pogledu incidence perioperativnog morbiditeta i mortaliteta. Ranom CEA se postiže znatno brži neurolo&scaron;ki oporavak pacijenata, naročito onih sa TIA i mRS&lt;3 skorom.</p> / <p>Objectives: The aim of this study was to investigate the safety of early carotid endarterectomy (CEA) in relation to the delayed CEA after acute ischemic neurological events (TIA / CVI). The second objective was to investigate whether there is a difference in speed of neurological recovery between these groups. Methods: A total of 157 patients in the prospective study followed 30 days postoperatively. Group I or early CEA, had 50 patients operated from 3 to 14 days after TIA / CVI event. Group II or delayed CEA, had 107 patients operated from 15 to 180 days after the TIA / CVI. Accompanied by the general and specific procedural morbidity and mortality in 30-day postoperative folow up. Rankin score (mRS) were used for evaluation of neurologic disability. In relation to the value of mRS score we formed two subgroups mRS &lt;3 i mRS3. In the statistical analysis we used the Pearson chi test, Student&#39;s test, ANOVA analysis of variance, Boniferony test and multiple analysis of variance for repeated measures (GLM- general line model), as well parametric and nonparametric correlation and regression. The significance level was 0.05. Results: The mean age was 66.72 years with 66.2% of males. In Group I is the average time to intervention was 9.5 days, and in group II 72.22 days. The groups were homogeneous in relation to risk factors and comorbidities. Group I had 54% of unstable atherosclerotic plaques compared with group II, where it was 31.8% (&chi;2 = 7.084; p &lt;0.01). In the group I TIA had 50% of respondents, while in group II CVI was 68.2% (&chi;2 = 4.825; p &lt;0.05). CVI to 1 cm in size were significantly more frequent in the group I, a CVI to 2 cm in group II (&chi;2 = 6.913; p &lt;0.05). CVI rate in the group I was 2.0%, and in group II was 2.8% (F = 0.083, p&gt; 0.05). Postoperative myocardial infarction (MI) in the group I is 2.0%, and in group II was 1.9%. Specific surgical morbidity rate in the group I and 4.0% in the group II 3.7%. In group I total morbidity was 6.0% in group II 7.5%, the difference was not statistically significant (F = 0.921; p&gt; 0.05). Mortality in both groups was not. CVI/IM/death rate in group I was 4.0% in group II was 4.7% (F = 0.122; p&gt; 0.05). Hyperlipidemia is a significant risk factor for CVI/IM/death (&chi;2 = 4.083; p&lt;0.05). Improving mRS in the group I had 52% and in group II 31.8% of patients (&chi;2 = 5.903; p &lt;0.01). The relative risk was 2.4 times as much and is more likely to occur in patients mRS changes if the patient in group I. Improving mRS that occurs between the third and tenth days after CEA was highly statistically significantly greater in the group of early CEA (F 3,701 df 1 p = 0.029). In patients with TIA in 60% of cases there was a decline mRS, and those had CVI in about 25.5% (&chi;2 = 18.050; p &lt;0.01). In Rankin score subgroups mRS &lt;3 i mRS 3 the decline was significant and time (F 18,774; df 6; p =0.000) and in the subgroup but it is far more rapid decline observed in the subgroup mRS &lt;3 (F 6.010; df 1; p = 0.003). Conclusions: Early CEA is as safe as the delayed CEA in respect incidence of perioperative morbidity and mortality. Early CEA is achieved significantly faster recovery of neurological patients, especially those with TIA and mRS &lt;3 compared with delayed CEA.</p>

<p>Povratak na posao nakon operacije lumbalne diskus hernije determinisan je funkcionalnim stanjem, prisustvom i stepenom tegoba od strane lumbosakralne kičme, zahtevima na radnom mestu bolesnika ali i psihosocijalnim faktorima, koji pri oceni radne sposobnosti zaposlnih zahtevaju individualni pristup. Grupa pacijenata koja se neće vratiti na posao može biti identifikovana putem prognostičkog modela. Cilj ove studije je definisanje prognostičkog modela za povratak na posao bolesnika operisanih zbog lumbalne diskus hernije kao i identifikacija najznačajnijih faktora rizika odgovornih za lo&scaron; ishod operativnog lečenja, posmatrano kroz prizmu povratka na posao. Istraživanje je prospektivna studija koja je obuhvatila ukupno 200 ispitanika, koji su operisani zbog lumbalne diskus hernije na jednom nivou i praćeni su u vremenskom period do 12 meseci nakon operativnog lečenja. U statističku ananlizu je u&scaron;lo 153 bolesnika, koji su ispunili kriterijume selekcije ispitanika studije. Nakon određivanja značaja posmatranih biolo&scaron;kih, profesionalnih i psihosocijalnih faktora rizika za povratak na posao, kreirani su i evaluirani prognostički modeli bazirani na svim i na odabranim atributima desetostrukom kros-validacijom: stablo odlučivanja (DT), model vi&scaron;eslojnih perceptrona (MLP) i model potpornih vektora (SVM). Za predviđanje povratka na posao najveću tačnost, specifičnost i senzitivnost za odabrane atribute postiže model potpornih - podržavajućih vektora (SVM). Najbolju intuitivnu i praktičnu vrednost za predviđanje povratka na posao pruža model stabla odluka (DT). Identifikacijom najznačajnijih faktora rizika za nepovoljan ishod povratka na posao omogućeno je preventivno delovanje na iste, u cilju smanjenja broja pacijenata sa umanjenjem radne sposobnosti i invaliditeta.</p> / <p>Return to work after lumbar discectomy is determinated by functional status, presence and degree of discomfort in the lumbosacral spine, the requirements in the workplace of patients and psychosocial factors that in the assessment of working capabilities require an individual approach. Groups of patients which don&rsquo;t return to work after surgery could be identified by predictive model. The aim of this study is to define prognostic model to return to work patients after lumbar discectomy, as well as the identification major risk factors responsible for the poor outcome of operative treatment viewed through the prism of returning to work. This prospective study included a total of 200 patients, who underwent surgery for lumbar disc herniation on one level and were followed up in period of 12 months following surgery. The statistical analysis included 153 patients who fulfilled all selection criteria of the study subjects. After determining significance of the observed biological, professional and psychosocial risk factors for return to work, prognostic models were designed and evaluated based on all and selected attributes by tenfold cross-validation: decision tree (DT) model of multilayer perception (MLP) model and support vector (SVM). For the prediction of return to work best accuracy, specificity and sensitivity for selected attributes, is achieved by supporting vector model (SVM). The decision tree model (DT) provides the best intuitive and practical value for predicting return to work. By identifying the most important risk factors for adverse outcome for return to work it is made possible for preventive actions, to reduce the number of patients with reduced work ability and disability.</p>

<p>Uvod: Stratifikacija rizika je postala integralna komponenta savremenog pristupa tretmanu u kliničkoj praksi. Danas se u dijagnostici i lečenju akutnog infarkta miokarda (AIM) koriste različiti skorovi rizika kao prognostički instrumenti za kratkoročan i dugoročan ishod bolesti. Nužni proceduralni procesi, u toku primarne perkutane koronarne intervencije (pPKI), kao i saznanja o distribuciji i vrstama lezija koronarnih arterija su od velikog značaja, te se preporučuje finalna evaluacija rizika neposredno nakon izvr&scaron;ene pPKI. Metode istraživanja podataka omogućavaju pronalaženje skrivenih obrazaca u podacima, otkrivanje njihovih uzročno-posledičnih veza I odnosa, te razvoj savremenih prediktivnih modela. Cilj: Kreiranje i testiranje jednostavnog, praktičnog i u svakodnevnoj praksi upotrebljivog prediktivnog modela za procenu intra-hospitalnog ishoda lečenja pacijenata obolelih od AIM sa ST-elevacijom (STEMI) lečenih pPKI. Metode: Istraživanje je unicentrična, retrospektivna, ali I prospektivna studija. U retrospektivnu studiju je uključeno 1495 pacijenta sa STEMI koji su lečeni na Klinici za kardiologiju Instituta za kardiovaskularne bolesti Vojvodine (IKVBV) kod kojih je u cilju rekanalizacije infarktne arterije izvr&scaron;ena pPKI, u periodu od decembra 2008. godine do decembra 2011. godine. Svaki pacijent je inicijalno predstavljen sa 629 obeležja sadržanih u postojećem IKVBV informacionom sistemu, koja čine demografske karakteristike, podaci iz anamneze i kliničkog nalaza, parametri biohemijskih analiza krvi priprijemu, parametri ehokardiografskog pregleda, angiografski i proceduralni detalji i &scaron;ifre prijemnih dijagnoza. U svrhu istraživanja podataka kori&scaron;ćeno je programsko re&scaron;enje otvorenog koda Weka. Tokom evaluacije različitih algoritama izabran je algoritam koji daje najbolje rezultate po tačnosti predikcije i ROC parametru. U sklopu retrospektivnog dela izvr&scaron;ena je validacija prediktivnog modela&nbsp; desetostrukom unakrsnom validacijom na celom skupu podataka. Prospektivnom studijom je na uzorku od 400 pacijenata sa STEMI lečenih pPKI u toku 2015. godine izvr&scaron;ena dodatna validacija razvijenog prediktivnog modela. Za iste pacijente je izračunavat i GRACE skor rizika, te je upoređena njegova, i prediktivna moć razvijenog modela. Rezultati: Alternativno stablo odluke (ADTree) izdvojen je kao algoritam sa najboljim performansama u odnosu na ostale evaluirane algoritme. Cost sensitive klasifikacija je kori&scaron;ćena kao dodatna metodologija da bi se pojačala tačnost. ADTree stablo odluke izdvojilo je osam ključnih parametara koji najvi&scaron;e utiču na ishod intra-hospitalnog lečenja: sistolni krvni pritisak pri prijemu, ejekciona frakcija leve komore, udarni volumen leve komore, troponin, kreatinin fosfokinaza, ukupni bilirubin, T talas i<br />rezultat intervencije. Performanse razvijenog modela su: tačnost predikcije je 93.17%, ROC 0.94. Razvijeni model je na prospektivnoj validaciji zadržao performanse: tačnost predikcije 90.75%, ROC 0.93. &Scaron;iroko kori&scaron;ćeni GRACE skor je na prospektivnom skupu postigao ROC=0.86, &scaron;to pokazuje da je razvijeni prediktivni model superiorniji u odnosu na njega. Zaključak: Razvijeni prediktivni model je jednostavan i pouzdan. Njegova implementacija u svakodnevnu kliničku praksu, omogućila bi kliničarima da izdvoje visokorizične pacijente, nakon reperfuzionog tretmana, a potom kod njih intenziviraju tretman i kliničko praćenje, a sa ciljem smanjenja incidence intra-hospitalnih komplikacija i povećanja njihovog preživljavanja.</p> / <p>Introduction: Risk stratification has become an integral component of modern treatment in clinical practice. Today, the diagnosis and treatment of acute myocardial infarction (AMI) use different risk scores as a prognostic instruments for short-term and long-term outcome of the disease. The necessary procedural processes during primary percutaneous coronary intervention (pPCI) as well as knowledge about the distribution and types of lesions in coronary arteries are of great importance, and a final risk evaluation is recommended directly after the pPCI. Methods of data mining allow finding hidden patterns in data, disclosure of their causal connections and relationships, and the development of modern predictive models. Aim: To create and test a simple, practical and usable predictive model in daily practice for the&nbsp; assessment of intrahospital treatment outcome of patients with AMI with STsegment elevation (STEMI) treated with pPCI. Methods: Presented research is unicentric, retrospective but also prospective study. Retrospective study included 1495 patients with STEMI who were admitted to the Clinics of cardiology of the Institute of Cardiovascular Diseases Vojvodina (IKVBV). For the purpose of recanalization of the infarct artery, pPCI has been performed to these patients during the period from December 2008 to December 2011. Each patient was initially described with 629 attributes from the existing information system of IKVBV. Those attributes consist of demographic characteristics, data from history and clinical findings, biochemical parameters of blood tests on admission, the echocardiographic parameters, angiographic and procedural details and admission diagnosis codes. For model development, an open source software solution Weka was used. During the evaluation of different algorithms, algorithm that gives the best results in terms of accuracy and ROC parameter was chosen. As part of the retrospective study, in order to assess the models performance, ten-fold cross-validation on the entire data set was used. A prospective study, on a sample of 400 patients with STEMI, treated with pPCI in 2015, performed additional validation of the developed predictive model. GRACE risk score was calculated for the prospective study patients and comparison with the developed model has been performed. Results: Alternative decision tree (ADTree) was isolated as an algorithm with the best performance in relation to other algorithms evaluated. Cost sensitive classification was used as an additional methodology to enhance accuracy. ADTree selected eight key parameters that most influence the outcome of intra-hospital treatment: systolic blood pressure on admission, left ventricular ejection fraction, stroke volume of the left ventricle, troponin, creatine phosphokinase, total bilirubin, T wave and the result of the intervention. The performance of the developed model are: the accuracy of the prediction is 93.17%, ROC 0.94. The developed model kept its performance in prospective validation: accuracy of prediction 90.75%, ROC 0.93. Widely used GRACE score achieved ROC = 0.86 in the prospective study patients, indicating that developed predictive model is superior to him. Conclusion: Developed predictive model is simple and reliable. Its implementation in everyday clinical practice, would allow clinicians to distinguish high-risk patients after reperfusion treatment, and then for them to intensify treatment and clinical follow-up, with an aim of reducing the incidence of intra-hospital complications and increase their survival.</p>

<p>Boljom prevencijom aterosklerotskih bolesti i uvođenjem invazivnih procedura endoluminalnim pristupom u lečenju koronarne bolesti i karotidne bolesti, hirur&scaron;ke procedure u poslednje dve decenije postaju sve kompleksnije i teže. Profil pacijenata podvrgnutih revaskularizaciji miokarda postaje sve rizičniji i procentualno se povećava broj polivaskularnih pacijenata za koje je neophodno uraditi dodatne procedure na karotidnim arterijama, bilo da su one urađene simultano, u dva ili tri akta. To su pacijenati koji imaju značajne aterosklerotske lezije na jednoj ili obe karotidne arterije zajedno sa značajnim suženjima koronarnih arterija. Algoritmi koji se nude u projektovanju operativne taktike ni danas nisu strogo definisani i vrlo često zavise od individualne procene i stava hirurga koji izvode ove procedure. Ishod operativnog lečenja ovih pacijenata često zavisi od hirur&scaron;ke taktike i ustanove u kojoj se oni operativno leče. Prediktori ishoda operativnog lečenja bi mogli biti važan faktor u selekcioniranju pacijenata u preporuci taktike operativnog lečenja. U tezi su analizirani klinički aspekti preoperativno i postoperativno, postoperativni mortalitet - 30 dana posle operacije i jednu godinu posle operacije. Analiziran je uticaj faktora: starost, pol, neurolo&scaron;ka disfunkcija, infarkt miokarda do 90 dana pre operacije, nestabilna angina, diabetes mellitus, bilateralna stenoza karotidnih arterija kod 94 pacijenta koji su operisani u Klinici za kardiohirurgiju Instituta za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici u periodu 2007-2012g. Kod svih je, preoperativno, nađeno da imaju značajne promene na koronarnim i karotidnim arterijama. Pacijenti su podeljeni u dve grupe po tipu izvr&scaron;ene operacije. Prvu grupu su sačinjavali pacijenti koji su operisani u odvojenim operacijama karotidnih arterija i revakularizacije miokarda, a drugi su operisani simultano operacijom karotidnih arterija i revaskularizacijom miokarda. U metodologiji su kori&scaron;ćene metode retrospektivnog i prospektivnog istraživanja. Kori&scaron;ćena je elektronska baza podataka Instituta za kardiovaskularne bolesti Vojvodine, vođen je intervju sa pacijentima. Kori&scaron;ćeni su i pregledi doppler sonografije karotidnih arterija koji su rađeni u drugim ustanovama. Mortalitet-30 dana i jednu godinu posle operacije je bio prihvatljivo nizak, pacijenti su pobolj&scaron;ani u posmatranim parametrima. Neurolo&scaron;ki morbiditet na 30 dana i jednu godinu posle je bio prihvatljivo nizak. Prediktori mortaliteta su bili pu&scaron;enje 30 dana i godinu dana posle operacije u obe grupe. Prediktor morbiditeta 30 dana i jednu godinu nakon operacije bila je hiperlipoproteinemija. Ženski pol je bio nezavisni prediktor mortaliteta u grupi pacijenata operisanih u vi&scaron;e aktova. Pacijenti operisini simultano su bili teži po simptomima ( NYHAklasi) i u većem riziku (EU2 score), ali nisu imali statistički značajno veću smrtnost u odnosu na grupu operisanu u vi&scaron;e aktova.</p> / <p>Surgical procedures have become more complex and difficult in the past two decades due to the better prevention of atherosclerotic diseases and the introduction of invasive procedures with endoluminal approach to treating coronary and carotid artery diseases. The profile of patients undergoing myocardial revascularization is becoming riskier. There is also increase in the percentage of patients with polyvascular disease who need additional procedures on the carotid arteries, whether they are done simultaneously or in two or three acts. These are the patients who have significant atherosclerotic lesions in one or both of the carotid arteries along with the significant narrowing of the coronary arteries. Algorithms that are offered to plan operative tactics are still not strictly defined and often depend on the individual assessment of surgeons and the attitude of certain institutions that perform the procedure. The outcome of surgical treatment of these patients often depends on surgical tactics and the institution in which they are treated. Predictors of surgical treatment outcome could be an important factor for the selection of patients and the recommendation of operative treatment tactics. The thesis analyzed pre- and postoperative clinical aspect as well as 30-day and one-year postoperative mortality. The influence of the following factors was analyzed: age, sex, neurologic dysfunction, myocardial infarction occurring 90 days after surgery, unstable angina, diabetes mellitus, and bilateral carotid artery stenosis in 94 patients that underwent cardiac surgery at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases of Vojvodina in Sremska Kamenica in the period from 2007 to 2012. All patients had significant changes on the coronary and carotid arteries. The patients were divided into two groups according to the type of surgery. The first group consisted of the patients who underwent carotid artery surgery and myocardial revascularization separately. The second group of patients underwent carotid artery surgery and myocardial revascularization at the same time. Methods of retrospective and prospective research were used in the methodology. Electronic data base of the Institute of Cardiovascular Diseases of Vojvodina was also used and the patients were interviewed. Doppler of carotid arteries performed both in our institution and in other institutions was used. Mortality, 30-day and one-year post surgery, was acceptably low. The patients were improved in the observed parameters. Neurologic morbidity 30 days and one year after surgery was acceptably low. Smoking 30 days and one year after surgery was predictor of mortality in both groups. Hyperlipoproteinemia 30 days and one year after surgery was predictor of morbidity. Female sex was independent predictor of mortality for the first group of patients. The second group of patients were more complex according to the symptoms (NYHA class) and with greater risk (EU2 score), but their mortality rate was not statistically significant in relation to the first group of patients.</p>

O presente estudo destinou-se a avaliar se os resultados clínicos iniciais da viscossuplementação poderiam ser melhorados com a adição de corticosteróide. As injeções intra-articulares são usadas há muitos anos no tratamento da osteoartrite dos joelhos, principalmente com suspensões cristalinas de corticosteróides. A viscossuplementação é uma intervenção relativamente nova, atualmente recomendada no tratamento da osteoartrite. Trata-se da injeção de ácido hialurônico exógeno em articulações diartrodiais, visando, além de restaurar as propriedades reológicas do líquido sinovial, efeitos modificadores da doença osteoartrite. Revisões sistemáticas mostram que a melhora clínica ocorre em duas a cinco semanas após a viscossuplementação. Comparando-se a viscossuplementação com a injeção intraarticular com corticosteróides, dados recentes sugerem maior eficiência no alívio da dor nas quatro primeiras semanas após a infiltração com corticosteróides, similaridade dos procedimentos ao redor da quarta semana e melhores resultados com a viscossuplementação após a oitava semana. Este inicio de ação mais tardio, associado a relatos de sinovite reacional após a viscossuplementação podem desencorajar médicos e pacientes ao uso desta modalidade de tratamento. No presente estudo foram avaliados 104 pacientes em tratamento para osteoartrite do joelho no grupo de doenças osteometabólicas do Instituto de Ortopedia do Hospital das Clínicas da FMUSP. Os pacientes foram randomizados em dois grupos. Um dos grupos foi denominado VS e recebeu uma única injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) no joelho estudado. O segundo grupo foi denominado VS+T e recebeu uma injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) mais 1ml (20mg) de Hexacetonido de Triancinolona (Triancil®-Apsen). Foram aplicados a escala visual analógica de dor (EVA) e os questionários de WOMAC e Lequesne uma semana antes da injeção e após uma, quatro, 12 e 24 semanas. Os dois grupos com 52 pacientes cada eram homogêneos. Na primeira semana, o WOMAC e a EVA apresentaram melhores resultados no Grupo VS+T (p < 0,01) em relação ao Grupo VS. Na quarta semana não houve diferença entre os grupos. Ambos apresentaram resultados similares nas semanas 12 e 24. Concluiu-se que a adição de hexacetonido de triancinolona melhorou os resultados clínicos da viscossuplementação no curto prazo, sem interferir nos resultados a longo prazo ou na incidência de efeitos adversos / The present study aims to assess if the initial results of viscosupplementation can be improved by the addition of corticosteroid. Intraarticular injections have been used for many years to treat arthritis and other painful articular disorders, mainly using long-lasting crystalline corticosteroid suspensions. Viscosupplementation is a relatively new intervention that is now widely used and recommended for the treatment of knee osteoarthritis. It is comprised of the injection of exogenous hyaluronic acid in diarthrodial joints, in order to restore the rheological properties of synovial fluid and also to promote osteoarthritis disease-modifying effects. Several placebo-controlled studies reported that clinical improvement began only within two to five weeks after viscosupplementation. When comparing viscosupplementation versus intraarticular injection of corticosteroid, recent data suggest that from baseline to week four, intraarticular steroid were more effective for pain relief. By the fourth week, however, both provided similar relief, but beyond the eighth week, hyaluronic acid provided greater pain reduction. The mechanism of action of hyaluronic acid, with delayed onset of pain/functional improvement, combined with reports of reactional sinovitis may discourage physicians and patients regarding this treatment modality. The present study evaluated 104 patients receiving usual care for knee osteoarthritis at the University of São Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) (Group VS) or a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) plus 1ml (20mg) of Triamcinolone Hexacetonide (Triancil®-Apsen) (Group VS+T). VAS, WOMAC and Lequesne questionnaires were applied one week prior the injection, and after one, four, 12 and 24 weeks. The two groups with 52 patients each were homogeneous. At week one, WOMAC and VAS showed better results for Group VS+T compared to Group VS (p < 0,05). At week four the scores did not show statistically significant differences. The groups showed similar results at weeks 12 and 24. In conclusion, the addition of triamcinolone improved first-week symptom and functional scores of viscosupplementation, but not beyond. It did not seem to alter the likelihood of adverse effects