Navegando por Palavras-chave "Multicenter"

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    Immediate versus delayed treatment for recently symptomatic carotid artery stenosis
    (Hindawi Publishing Corp, 2016) Vasconcelos, Vladimir [UNIFESP]; Cassola, Nicolle [UNIFESP]; da Silva, Edina M. K.; Baptista-Silva, Jose C. C. [UNIFESP]
    Background The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. Objectives To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. Search methods We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL
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    Transient elastography and apri score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis c
    (Hindawi Ltd, 2016) Mendes, L. C.; Ferreira, P. A. [UNIFESP]; Miotto, N.; Zanaga, L.; Goncales, E.; Lazarini, M. S.; Goncales Junior, F. L.; Stucchi, R. S. B.; Vigani, A. G.
    Although long regarded as the gold standard for liver fibrosis staging in chronic hepatitis C (CHC), liver biopsy (LB) implies both the risk of an invasive procedure and significant variability. The aim of this study was to evaluate the diagnostic performance for transient elastography (TE) and aspartate aminotransferase to platelet index (APRI) used alone and in combination compared to liver biopsy and to analyze false positive/negative results. Patients with CHC, and no previous clinical diagnosis of cirrhosis were enrolled to undergo liver biopsy, TE and APRI. A total of 182 adult patients with a median age of 55 years and median body mass index of 26.71 kg/m(2) were analyzed. On LB, 56% of patients had significant levels of fibrosis (METAVIR F >= 2) and 28% had advanced fibrosis (F3/F4). The strongest performance for both tests was observed for exclusion of advanced fibrosis with good negative predictive values (89 and 86%, respectively). Low necroinflammatory activity on LB was associated with false negative TE. False positives were associated with NASH and smaller LB fragments. Correlation between APRI and Fibroscan for F >= 2 was 100% and 84% for F >= 3 and remained high in both false negative and false positive instances, correctly identifying F < 2 in 71% of cases and F < 3 in 78% (and potentially foregoing up to 84% of LB). We concluded that low individual performance indicators could be attributable to limitations of LB. Poorer differentiation of lower levels of fibrosis is a known issue for LB and remains so for noninvasive tests. Good predictability is possible, however, for advanced fibrosis.