DSpace Collection:http://cmuir.cmu.ac.th/jspui/handle/6653943832/75812024-03-19T02:47:59Z2024-03-19T02:47:59Zเปรียบเทียบการประเมินพังผืดในเนื้อเยื่อไตระหว่างวิธีการประเมิน ด้วยสายตาและประเมินโดยใช้การวิเคราะห์ภาพดิจิตอลในผู้ป่วยไต อักเสบจากโรคลูปัสธนาณัติ สืบวงศ์นิรัตน์http://cmuir.cmu.ac.th/jspui/handle/6653943832/400332017-09-11T01:52:09ZTitle: เปรียบเทียบการประเมินพังผืดในเนื้อเยื่อไตระหว่างวิธีการประเมิน ด้วยสายตาและประเมินโดยใช้การวิเคราะห์ภาพดิจิตอลในผู้ป่วยไต อักเสบจากโรคลูปัส
Authors: ธนาณัติ สืบวงศ์นิรัตน์
Abstract: Background: Prediction of the renal outcomes is crucial for patients with lupus nephritis due to high morbidity and mortality. Renal interstitial fibrosis is correlated with progression to renal failure. However evaluation of interstitial fibrosis by subjective visual assessment comparing with digital image analysis has not been well studied.
Method: Seventy-five kidney core biopsies diagnosed with lupus nephritis at Chiang Mai University hospital during July 1st, 2011 to December 31th, 2012 were retrieved from database. Interstitial fibrosis in percentage was assessed on scanned PicroSirius red stained histological images (Aperio) using software analysis. Visual assessment was performed under a light microscope by two pathologists (SS, SL). Clinical, laboratory data and renal outcomes (end-stage renal disease (ESRD), doubling serum creatinine (DSC), dialysis and complete remission (CR)) were collected retrospectively from the time of biopsy to the last follow-up.
Result: Interstitial fibrosis evaluated by image analysis (IF-IA) showed better intraobserver (Pearson correlation coefficient: r=0.98, p<0.001 VS r=0.85, p<0.001) and interobserver reliability (r=0.79, p<0.001 VS r=0.61, p=0.001) compared with interstitial fibrosis evaluated by visual assessment (IF-VA) While IF-VA showed a greater negative correlation with baseline estimated glomerular filtration rate (eGFR) (r= -0.458, p<0.001) compared with IF-IA (r= -0.246, p=0.033). A significantly greater degree of IF-VA was observed in patients with subsequent ESRD, DSC and dialysis; and a significantly lesser degree of IF-VA was observed in patients with CR compared with patients without these outcomes. Whilst there is no difference in IF-IA between patients with and without such renal outcomes. Univariate survival analysis (log-rank test) showed IF-VA, IF-IA, serum creatinine, hematocrit, serum C3 protein and eGFR were predictive of all adverse renal outcomes. However multivariate Cox-hazard analysis demonstrated that only IF-VA was an independent predictor for ESRD (Hazard ratio: 1.062, 95% confidence interval: 1.034-1.092, p<0.001). Using Kaplan-Meier curves and log-rank test, IF-VA but not IF-IA, is inversely associated with renal survival from ESRD, DSC and dialysis (P<0.001). The median renal survival of ESRD in patient with IF-VA >50% was 2.1 months compared with 27.16 months in those with IF-VA 25-50%.
Conclusion: Renal interstitial fibrosis evaluated by digital image analysis is more reliable and precise, however assessing by visual assessment is more predictive of renal outcomes in lupus nephritis patients.การศึกษาความชุกของภาวะเบาหวานในขณะตั้งครรภ์โดยการตรวจสอบ ด้วย 75 กรัม OGTTเพ็ญพรรณ บุตรชัยงามhttp://cmuir.cmu.ac.th/jspui/handle/6653943832/399612017-08-25T02:33:01ZTitle: การศึกษาความชุกของภาวะเบาหวานในขณะตั้งครรภ์โดยการตรวจสอบ ด้วย 75 กรัม OGTT
Authors: เพ็ญพรรณ บุตรชัยงาม
Abstract: Objective: To study the prevalence and pregnancy outcomes of gestational diabetes mellitus (GDM) screened by 75-g oral glucose tolerance test (75-g OGTT) among pregnant Thai women.
Methods: All werescreened for GDM using 75-g OGTT and were followed-up until delivery.
Results: Of 190 recruited pregnancies with complete data, 65 had abnormal 75-g OGTT, diagnosed as GDM, and 125 had no GDM. The prevalence of GDM was 34.2% (65 out of 190). Baseline characteristics in the group with GDM and the normal group were not significant different. Similarly, all pregnancy outcomes were not significantly different between the two groups.
Conclusion: New approach using 75-g OGTT was associated with high prevalence of GDM, without clear demonstration of improvements in the most clinically important pregnancy outcomesความสัมพันธ์ของPAPP-A ในช่วงไตรมาสแรกกับสภาวะคลอดก่อนกำหนดปิยธิดา ภุมราhttp://cmuir.cmu.ac.th/jspui/handle/6653943832/399602017-08-25T02:25:16ZTitle: ความสัมพันธ์ของPAPP-A ในช่วงไตรมาสแรกกับสภาวะคลอดก่อนกำหนด
Authors: ปิยธิดา ภุมรา
Abstract: Background: Preterm birth is the most common direct cause of neonatal death, especially in developing countries. The rate, in our region, northern part of Thailand, is as high as 15% of live births Additionally, the rates of preterm birth are increasing. All attempts must be made to prevent this serious event.
Objective: To determine the strength of relationship between PAPP-A concentrations using Thai-specific reference range, and rates of idiopathic preterm delivery
Methods: The records of singleton pregnancies, undergoing first-trimester screening for fetal Down
syndrome, between January 2007 and July 2012, were accessed. Serum PAPP-A levels were measured and divided into 2 groups, a group of normal PAPP-A levels (>10th percentile) and a group of low PAPP-A levels (< 10th percentile). The main outcome is the rate of idiopathic preterm births before 37, 34 and 32 weeks of gestation in the two groups
Results: The rates of spontaneous preterm birth at <37, <34 and <32 weeks of gestation were significantly higher in women with low PAPP-A levels, (7.6% vs 17.9%, 3.1% vs 11.9%, 2.2% vs 11.9%), with a relative risk of 2.37, 3.79, and 5.41 for preterm birth, respectively (P value < 0.001)
Conclusion: In children with asthma and allergic rhinitis attending Allergy Clinic at CMU Hospital, indoor allergen was more important than outdoor allergens in all age groups. Increased sensitization to pollen was observed in the past 10 years. Children with two or more allergic disease had higher chance of sensitization. Sensitization rates and frequency of polysensitization tended to increase with age.สัณฐานวิทยาของภาวะหลอดเลือดแดงใหญ่ส่วนช่องท้องโป่งพองที่มีผลต่อการรักษาผ่านสายสวนหลอดเลือดภูวิชญ์ เจริญเชื้อhttp://cmuir.cmu.ac.th/jspui/handle/6653943832/398942017-04-11T20:05:55Z2015-04-01T00:00:00ZTitle: สัณฐานวิทยาของภาวะหลอดเลือดแดงใหญ่ส่วนช่องท้องโป่งพองที่มีผลต่อการรักษาผ่านสายสวนหลอดเลือด
Authors: ภูวิชญ์ เจริญเชื้อ
Abstract: Objective: To evaluate the morphology of infrarenal AAA, the proportion of the patients with AAA would be eligible for EVAR and to identify the morphologic features unfit for minimal requirements for standard commercially available endografts.
Methods and Materials: We retrospective review CT images of 94 patients with AAA from our radiology database from September 2013 to November 2014. Images were reconstructed for morphologic features evaluation and measurements. Eligibility criteria determined by manufacturer and published guideline were applied for patients who fit with those requirements.
Results: The mean age was 73.03±8.0 years and 57.45% of patients were men. Most of the patients had grade 3 aneurysmal sac thrombus. The most common type of the proximal neck was parallel. The average size of the aneurysm sac was 56.8±15.4 mm. Iliac artery diameter in men was larger than women. Among the Asians, Thais had smaller external iliac artery with mean diameter of 6.8 to 6.9 mm. Severe aortic tortuosity was found in 22.3%. Severe right and left iliac tortuosity were found in 27.7% and 28.3%. Eligibility for EVAR by European Society for Vascular Surgery, Zenith Flex®, Excluder® and Endurant II® were 5.3%, 33.0%, 26.6% and 39.4% respectively
Conclusion: As compared to the Westerns and other Asians, Thais have smaller EIA diameter. This is a major reason for ineligibility for EVAR in Thais, contrast to the proximal neck problems in the others. Our study supports development of devices with smaller profile, then devices with more coverage range for proximal neck diameter and angulation that would be benefit for AAA patients.
Keywords: Abdominal aortic aneurysm, Infrarenal, Endovascular, EVAR, Morphology2015-04-01T00:00:00Z