Summary Background Surgery is increasingly used as treatment for refractory focal epilepsy; however, few rigorous reports of long-term outcome exist. We did this study to identify long-term outcome ...of epilepsy surgery in adults by establishing patterns of seizure remission and relapse after surgery. Methods We report long-term outcome of surgery for epilepsy in 615 adults (497 anterior temporal resections, 40 temporal lesionectomies, 40 extratemporal lesionectomies, 20 extratemporal resections, 11 hemispherectomies, and seven palliative procedures corpus callosotomy, subpial transection), with prospective annual follow-up for a median of 8 years (range 1–19). We used Kaplan-Meier survival analysis to estimate time to first seizure, and investigated patterns of seizure outcome. Findings We used survival methods to estimate that 52% (95% CI 48–56) of patients remained seizure free (apart from simple partial seizures SPS) at 5 years after surgery, and 47% (42–51) at 10 years. Patients who had extratemporal resections were more likely to have seizure recurrence than were those who had anterior temporal resections (hazard ratio HR 2·0, 1·1–3·6; p=0·02); whereas for those having lesionectomies, no difference from anterior lobe resection was recorded. Those with SPS in the first 2 years after temporal lobe surgery had a greater chance of subsequent seizures with impaired awareness than did those with no SPS (2·4, 1·5–3·9). Relapse was less likely the longer a person was seizure free and, conversely, remission was less likely the longer seizures continued. In 18 (19%) of 93 people, late remission was associated with introduction of a previously untried antiepileptic drug. 104 of 365 (28%) seizure-free individuals had discontinued drugs at latest follow-up. Interpretation Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy. Funding UK Department of Health National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme, Epilepsy Society, Dr Marvin Weil Epilepsy Research Fund.
Abstract
Aims
It remains unknown whether the treatment of hypertension influences the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19).
Methods and results
This is a ...retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Hypertension and the treatments were stratified according to the medical history or medications administrated prior to the infection. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension 4.0% vs. 1.1%, adjusted hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.17–3.82, P = 0.013. Patients with a history of hypertension but without antihypertensive treatment (n = 140) were associated with a significantly higher risk of mortality compared with those with antihypertensive treatments (n = 730) (7.9% vs. 3.2%, adjusted HR 2.17, 95% CI 1.03–4.57, P = 0.041). The mortality rates were similar between the renin–angiotensin–aldosterone system (RAAS) inhibitor (4/183) and non-RAAS inhibitor (19/527) cohorts (2.2% vs. 3.6%, adjusted HR 0.85, 95% CI 0.28–2.58, P = 0.774). However, in a study-level meta-analysis of four studies, the result showed that patients with RAAS inhibitor use tend to have a lower risk of mortality (relative risk 0.65, 95% CI 0.45–0.94, P = 0.20).
Conclusion
While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously.
An increasing number of ideal cardiovascular health factors have been associated with a lower prevalence and incidence of ASCVD events, heart failure, atrial fibrillation, cancer, depression, and ...cognitive impairment (S1-7). ...moving individuals toward ideal cardiovascular health is critically important for prevention of many important health conditions. ...it is difficult, perhaps impossible, to assess long-term effectiveness in terms of survival or quality-adjusted life-years (QALYs) or associated costs because of increasing uncertainty about outcome the further one tries to look into the future.” ...social determinants of ASCVD risk—and their impact on the patient’s ability to prevent or treat risk factors—must be taken into account. High blood pressure ▪Short sleep duration (<6 h) and poor-quality sleep are associated with high blood pressure and should be considered (S2.1-41). Because other lifestyle habits can impact blood pressure, access to a healthy, low-sodium diet and viable exercise options should also be considered.
A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Endorsed by the American Association of Cardiovascular and Pulmonary ...Rehabilitation, the American Geriatrics Society, the American Society of Preventive Cardiology, and the Preventive Cardiovascular Nurses Association
Cardiovascular disease (CVD) risk scores provide point estimates of individual risk without uncertainty quantification. The objective of the current study was to demonstrate the feasibility and ...clinical utility of calculating uncertainty surrounding individual CVD-risk predictions using Bayesian methods.
Individuals with established atherosclerotic CVD were included from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (UCC-SMART). In 8,355 individuals, followed for median of 8.2 years (IQR 4.2-12.5), a Bayesian Weibull model was derived to predict the 10-year risk of recurrent CVD events. Model coefficients and individual predictions were very similar to that of a traditional (‘frequentist’) model but the Bayesian model also predicted 95% credible intervals (CIs) surrounding individual risk estimates. The median width of the individual 95%CrI was 5.3% (IQR 3.6-6.5) and 17% of the population had a 95%CrI width of 10% or greater. The uncertainty decreased with increasing sample size used for derivation of the model. Combining the Bayesian Weibull model with sampled hazard ratios based on trial reports may be used to estimate individual absolute risk reduction with uncertainty measures and the probability that a treatment option will result in a clinically relevant risk reduction.
Estimating uncertainty surrounding individual CVD risk predictions using Bayesian methods is feasible. The uncertainty regarding individual risk predictions could have several applications in clinical practice, like the comparison of different treatment options or by calculating the probability of the individual risk being below a certain treatment threshold. However, as the individual uncertainty measures only reflect sampling error and no biases in risk prediction, physicians should be familiar with the interpretation before widespread clinical adaption.
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•It is feasible to estimate uncertainty surrounding individual CVD risk predictions.•Calculating uncertainty with Bayesian methods may have several applications.•One example is calculating the probability of being above risk thresholds.•Individual uncertainty only reflects sampling error and no biases in risk prediction.
Bacterial biofilms can cause problems in various arenas, from the fouling of water processing equipment to persistent in vivo infections. Silver nanoparticles are promising antimicrobial agents with ...activity against biofilm bacteria. Here we describe the synthesis of antimicrobial silver nanoparticles and the measurement of their antimicrobial activity against E. coli colony biofilms, which is a popular in vitro biofilm model for antibiotic assays.
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