جستجوی مقالات مرتبط با کلیدواژه "multistate model" در نشریات گروه "پزشکی"
-
Background
One of the most appropriate methods for analyzing longitudinal data is multistate model. This study has aimed to evaluate the risk factors of transfer to local recurrence (LR), distant metastasis (DM), and death in rectal cancer patients through multistate survival analysis.
Materials and MethodsThis is a retrospective cohort of rectal cancer patients in Mashhad, Iran. Multistate models were applied to show the difference between the significant risk factors affecting death and recurrence in different defined transitions. Risk factors include age, sex, primary surgical technique, tumor location, postoperative tumor stage, circumferential or distal resection involvement, surgery time, and surgical complications.
ResultsA total of 280 eligible patients with a median (interquartile range) survival time of 60 (42-76.2) months were investigated. Based on Cox proportional ultistate model, the hazard ratio (HR) of DM increases by 3%/1?year increase in age (P = 0.018). The HR of DM and the HR of LR in patients with postoperative disease Stage II/III were 3.06 and 2.53 times higher than patients with cancer Stage 0/I (P < 0.05). When the resection margins of distal or circumferentialwere involved, the HR of DM was 3.58 times higher than those patients without involvement. In the extended multistate model, time of DM was a significant predictor of death (P = 0.006).
ConclusionAge and margin involvement in DM path and stage in LR and DM path had a significant effect; however, no effective variable was seen on the death of patients with recurrence. The time of metastasis also had an effect on the path of death.
Keywords: Distant Metastasis, Local Recurrence, Multistate Model, Rectal Cancer, Survival -
زمینه و هدف
سندرم نقص ایمنی انسان که ناشی از ویروس HIV است، یک بیماری مزمن و بالقوه تهدیدکننده زندگی به شمار می آید. عوامل متعددی در ابتلا و پیشرفت آن اثرگذار هستند، بنابراین مطالعه حاضر سعی می کند عوامل موثر بر پیش آگهی و پیشرفت بیماری HIV را با استفاده از مدل های چندحالتی شناسایی کند.
مواد و روش هامطالعه گذشته نگر حاضر متشکل از 2185 بیمار مبتلا به HIV مراجعه کننده به مراکز مشاوره بیماری های رفتاری شهر تهران از سال 1383 تا 1392 است. ما حالات چندگانه ایدز، سل و سل/ ایدز را در سیر طبیعی بیماری (از زمان شروع بیماری HIV تا رخداد مرگ) در نظر گرفتیم، سپس با به کارگیری مدل های چندحالتی اثر متغیرهای جمعیت شناختی و بالینی را بر زمان بقا و سپس احتمالات گذار HIV بررسی کردیم.
ملاحظات اخلاقیکمیته اخلاق پژوهشی دانشگاه علوم پزشکی همدان این مطالعه را با کد IR.UMSHA.REC.1396.117 به ثبت رسانده است.
یافته هامرگ ناشی از HIV در افراد با سابقه زندان 40/2 برابر افراد بدون سابقه زندان بود. این خطر در افراد 25 تا 44 سال و بیشتر از 44 سال نیز به ترتیب 1/70 و 1/80 برابر افراد کمتر از 25 سال بود. رابطه معکوسی هم بین سطوح CD4 و مرگ در بین شرکت کنندگان در مطالعه ما مشاهده شد.
نتیجه گیریدرمان ضدرتروویروسی، تعداد سلول های CD4، سن و سابقه زندان از مهم ترین عوامل در پیشرفت بیماری و مرگ بیماران HIV بود، بنابراین جلوگیری از گسترش بیشتر بیماری به جامعه و کنترل بیماری در مبتلایان نیازمند مداخلات آموزشی و درمانی هدفمند است که در آن هم افراد جامعه با راه های انتقال و پیشگیری از بیماری آشنا شوند و هم بیماران برای مراجعه زودهنگام به مراکز درمانی رغبت پیدا کنند.
کلید واژگان: مدل چندحالتی, حالت میانی, HIV, ایدز, سلBackground and AimAcquired Immunodeficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV), is a chronic and potentially life-threatening disease. Numerous factors affect its development and progression. Therefore, the present study attempted to identify characteristics impacting the prognosis and progression of AIDS using multistate models.
Methods & MaterialsThe present retrospective study consisted of 2185 patients affected with HIV referring to Behavioral Disease Counseling Centers in Tehran City, Iran, from 2004 to 2013. We considered multiple states of AIDS, tuberculosis, and tuberculosis/AIDS in the natural history of the disease (from the onset of HIV disease until death occurred). Then, we applied the multistate models, to examine the effect of contextual demographic and clinical variables on survival time; subsequently, the transition probabilities of HIV.
Ethical ConsiderationsThis study was approved by the Research Ethics Committee of Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1396.117).
ResultsHIV-Related deaths in individuals with an incarnation history were 2.40 times higher than in those without the prison history. Death risk was also 1.70 and 1.80 times higher in those aged 25-44 and 44 years, respectively, compared to the individuals aged less than 25 years. An inverse relationship was also found between CD4 levels and the risk of death in our participants.
ConclusionAntiretroviral therapy, CD4 count, age, and history of imprisonment were the main factors in the progression of the disease and subsequent death in HIV patients. Thus, preventing the further spread of the disease to the community and controlling the disease in the patients requires targeted educational and therapeutic interventions; accordingly, the community will be familiarized with transmission routes and the preventing principle of disease. Furthermore, we can encourage patients to visit the healthcare centers early.
Keywords: Multistate model, Intermediate state, Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), Tuberculosis -
International Journal of Hematology-Oncology and Stem Cell Research, Volume:12 Issue: 1, Jan 2018, PP 57 -64BackgroundHodgkin's lymphoma (HL) is a unique cancer of lymphocytes that has unknown reason. As lymphocytes are found throughout the lymphatic system, HL can start almost anywhere in the body. It usually starts in a group of lymph nodes in one part of the body; it usually spreads in a predictable form, from one group of lymph nodes to the next. Eventually, it can spread to almost any tissue or organ in the body through the lymphatic system or the bloodstream. So it's important to evaluate the prognostic factors of mortality and recurrence. The aim of this study is to use multistate model to consider the event history of patients and assess important prognostic factors.Materials And MethodsWe performed a retrospective review on 389 patients with Hodgkin's disease referred to the Oncology and Hematology Center, Shafa Hospital, Ahvaz during 2002 and 2012. An illness death model was fitted to assess the hazard of transitions during the course of the disease for each prognostic factor.ResultsThe results showed that the prevalence rate was higher in male population ≥50 years of age with a hemoglobin level of less than 10.5 g per deciliter and diagnosis of advanced stage of disease. The risk of death for males was twice more than females (HR=2.07). Moreover, patients with mediastina and spleen involvement were more than others in danger of death (1.66 and 1.36, respectively).ConclusionIn conclusion, the multistate model offers an appropriate method to consider the event history of patients and determine main prognostic factors, which play an important role in rapid diagnosis and choosing the best treatment choice for each patient.Keywords: Hodgkin's lymphoma, Multistate model, Prognostic factors, Markov illness-death model
- نتایج بر اساس تاریخ انتشار مرتب شدهاند.
- کلیدواژه مورد نظر شما تنها در فیلد کلیدواژگان مقالات جستجو شدهاست. به منظور حذف نتایج غیر مرتبط، جستجو تنها در مقالات مجلاتی انجام شده که با مجله ماخذ هم موضوع هستند.
- در صورتی که میخواهید جستجو را در همه موضوعات و با شرایط دیگر تکرار کنید به صفحه جستجوی پیشرفته مجلات مراجعه کنید.