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1
Bowe, Benjamin, Yan Xie, Tingting Li, Yan Yan, Hong Xian und Ziyad Al-Aly. „Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution“. BMJ Open 9, Nr. 5 (Mai 2019): e022450. http://dx.doi.org/10.1136/bmjopen-2018-022450.
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ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5in 194 countries and territories. Population-weighted PM2.5levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.SettingGBD global and national data on PM2.5and CKD.Participants194 countries and territories.Main outcome measuresWe estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).ResultsThe 2016 global burden of incident CKD attributable to PM2.5was 6 950 514 (95% uncertainty interval: 5 061 533–8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM2.5were 2 849 311 (1 875 219–3 983 941), 8 587 735 (6 355 784–10 772 239) and 11 445 397 (8 380 246–14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16–707.96) in El Salvador, 455.29 (332.51–577.97) in Mexico, 408.41 (283.82–551.84) in Guatemala, 238.25 (173.90–303.98) in India and 178.26 (125.31–238.47) in Sri Lanka, compared with 5.52 (0.82–11.48) in Sweden, 6.46 (0.00–14.49) in Australia and 12.13 (4.95–21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.ConclusionsOur results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.
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Kotapati, Sravanthi, Insija Ilyas Selene, Madeeha Shafqat, Syeda Fatima Hassan, Zunairah Shah, Arshia Akbar, Owais ur Rehman et al. „Efficacy and Toxicity of Lenalidomide for Treatment of Chronic Lymphocytic Leukemia: A Systematic Review and Meta-Analysis“. Blood 134, Supplement_1 (13.11.2019): 5488. http://dx.doi.org/10.1182/blood-2019-129733.
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Background: During last decade, several therapeutic options have emerged for newly diagnosed (ND) or relapsed / refractory (RR) patients with chronic lymphocytic leukemia (CLL). Lenalidomide (Lena) has immunomodulatory, anti-angiogenic and antitumor activity. Lena is showing antitumor activity against CLL with durable responses.The main aim of our analysis is to study the published literature on the efficacy and safety of Lena based regimens in patients with ND and RR CLL. Methods: We performed the literature search (10/5/2019) using following databases (PubMed, Embase, Cochrane Library, Web of Science, and Clinical trials.gov) identified a total of 4835 articles. Following PRISMA guidelines, we selected twenty articles (Phase I/II/III) with a total of 1309 patients (pts) in which eleven articles (n= 914) were about ND CLL pts and nine articles (n=396) had pts with RR CLL. CMA software v.3 was used for meta-analysis. Results: Lenalidomide based regimens in previously untreated CLL Based on the pooled analysis,(table 1)(an overall response rate (ORR) of 59.9% (95% CI: 55.4-64.2) with complete response (CR) of 17.6% (95% CI: 8.9-31.8) is observed in previously untreated CLL and ORR of 57.6% (95% CI: 50.4-64.4) with a CR of 12.9% (95% CI: 7.7-20.8) in RR CLL were calculated. Most common grade (G) ≥3 adverse events (AE's) based on regimen were calculated using pooled analysis in CLL pts and results are given intable2. Lena in single drug regimen: Three studies (n=445) evaluated the efficacy of Lena as single agent (5mg-25mg). Subgroup pooled analysis showed an ORR of 56.4% (95% CI: 51.6-61) with CR of 7.3% (95% CI: 4.4-11.3). Pooled analysis for safety profile on most common G ≥3 AE's were neutropenia 72.2% (95% CI: 45.1-89.2), thrombocytopenia (tcp) 29.7% (95% CI: 9.1-64), anemia 0.8% (95% CI: 0.1-11.1), fatigue 3% (95% CI: 1.5-5.8) and infections 5% (95% CI: 1.22-18.7). Lena in two drug regimen: One study (n=69) evaluated the efficacy of Lenaas double regimen with ofatumumab. Sub-group pooled analysis showed an ORR of 88% (95% CI: 78-93.8) with CR of 16% (95% CI: 9.1-26.6). Best response was seen when Lena was used with Ofatumumab, with reported ORR of 71%. Pooled analysis for safety profile on most common G ≥3 AE's were neutropenia 58% (95% CI: 46.1-69), anemia 10% (95% CI: 4.8-19.6), tcp 3% (95% CI: 0.8-11) and fatigue 6% (95% CI: 2.3-14.7). Lena in three drug regimen: For six studies (n=375), a pooled analysis on Lena as three drug regimen calculated an ORR of 59.2% (95% CI: 45.2-86) with CR of 24.1% (95% CI: 18.5-30.7). Pooled analysis for safety profile on most common G ≥3 AE's were neutropenia 55% (95% CI: 28.4-79.1), tcp 17.6% (95% CI: 6.1-41.3), anemia 13.9% (95% CI: 4.2-37.5), fatigue 29.1% (95% CI: 0.8-95.6) and infection 10.4% (95% CI: 5.6-18.5). Lena in four drug combination regimen: One study (n=25) evaluated Lena in quadruple regimen (Lena, rituximab, cyclophosphamide and fludarbine) with ORR of 98.1% (95% CI: 75.6-99.9) with CR 75% (95% CI: 54.8-88.1). Pooled analysis for common AE's were neutropenia of 51.6% (95% CI: 37.7-70), tcp of 1.6% (95% CI: 0.1-27), anemia of 1.6% (95% CI: 0-27) and infections of 3% (95% CI: 0.3-23.5) Lena based regimens in Relapsed or Refractory (RR) CLL Nine studies ( n=396)(table 1) evaluated the efficacy of Lena in RR CLL and have given promising results in these pts. Three studies (n=209) evaluated the efficacy of Lena as single agent, pooled analysis (95% CI) on Lena as mono measured an ORR of 32.7% (95% CI: 15.1-57)(fig. 1) with CR of 8.8% (95% CI: 3.1-22.8). Similarly subgroup pooled analysis for double regimen which includes four studies (n=139) measured ORR of 63.2% (95% CI: 54.4- 71.3) with CR of 14% (95% CI: 5.7-30.4). Two studies (n=56) evaluated Lena as triple regimen, an ORR of 52.5% (95% CI: 39.5-65.2) with CR of 21% (95% CI: 10.4-37.8) was calculated. Pooled analysis (95% CI) common G ≥3 AE's are neutropenia 69.9% (62.8-76.2), tcp 26.5% (18.4-36.5), anemia 9.4% (6.4-13.5), infections 29.4% (10.7-59) and fatigue 14.6% (6.2-30.6)(table 2) Conclusion: Lenalidomide is highly efficacious when used for treatment of previously untreated or RR CLL. Regimen efficacy is greater in untreated CLL compared to RR CLL. Four drug Lena based combination regimen showed the best result with an ORR of 98.1% (95%CI: 75.6-99.9). Large prospective studies are required to evaluate efficacy and safety of Lena in newer combination regimens. Disclosures Anwer: In-Cyte: Speakers Bureau; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.
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Christensen, S. „Removal of haem from lipids extracted from intact erythrocytes with particular reference to polyphosphoinositides“. Biochemical Journal 233, Nr. 3 (01.02.1986): 921–24. http://dx.doi.org/10.1042/bj2330921.
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With the use of a modified acid version of a current lipid-extraction technique [Bligh & Dyer (1959) Can. J. Biochem. Physiol. 37, 911-917], 92% of phosphatidylinositol 4,5-bisphosphate obtained by means of three sequential extractions from intact human erythrocytes was obtained during the first one. Some 95% of the haem co-extracted with the lipids could then be removed, with a maximal loss of polyphosphoinositides of less than 3%. About 58 nmol of phosphatidylinositol 4,5-bisphosphate was found per ml of erythrocytes.
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Bradbury, Charlotte A., Zoe Craig, Gordon Cook, Charlotte Pawlyn, David A. Cairns, Anna Hockaday, Andrea Paterson et al. „Thrombosis in patients with myeloma treated in the Myeloma IX and Myeloma XI phase 3 randomized controlled trials“. Blood 136, Nr. 9 (27.08.2020): 1091–104. http://dx.doi.org/10.1182/blood.2020005125.
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Abstract Newly diagnosed multiple myeloma (NDMM) patients treated with immunomodulatory drugs are at high risk of venous thromboembolism (VTE), but data are lacking from large prospective cohorts. We present thrombosis outcome data from Myeloma IX (n = 1936) and Myeloma XI (n = 4358) phase 3 randomized controlled trials for NDMM that treated transplant-eligible and transplant-ineligible patients before and after publication of thrombosis prevention guidelines. In Myeloma IX, transplant-eligible patients randomly assigned to cyclophosphamide, vincristine, doxorubicin, and dexamethasone (CVAD) induction had higher risk of VTE compared with patients treated with cyclophosphamide, thalidomide, and dexamethasone (CTD) (22.5% [n = 121 of 538] vs 16.1% [n = 89 of 554]; adjusted hazard ratio [aHR],1.46; 95% confidence interval [95% CI], 1.11-1.93). For transplant-ineligible patients, those randomly assigned to attenuated CTD (CTDa) induction had a higher risk of VTE compared with those treated with melphalan and prednisolone (MP) (16.0% [n = 68 of 425] vs 4.1% [n = 17 of 419]; aHR, 4.25; 95% CI, 2.50-7.20). In Myeloma XI, there was no difference in risk of VTE (12.2% [n = 124 of 1014] vs 13.2% [n = 133 of 1008]; aHR, 0.92; 95% CI, 0.72-1.18) or arterial thrombosis (1.2% [n = 12 of 1014] vs 1.5% [n = 15 of 1008]; aHR, 0.80; 95% CI, 0.37-1.70) between transplant-eligible pathways for patients treated with cyclophosphamide, lenalidomide, and dexamethasone (CRD) or CTD. For transplant-ineligible patients, there was no difference in VTEs between attenuated CRD (CRDa) and CTDa (10.4% [n = 95 of 916] vs 10.7% [n = 97 of 910]; aHR, 0.97; 95% CI, 0.73-1.29). However, arterial risk was higher with CRDa than with CTDa (3.1% [n = 28 of 916] vs 1.6% [n = 15 of 910]; aHR, 1.91; 95% CI, 1.02-3.57). Thrombotic events occurred almost entirely within 6 months of treatment initiation. Thrombosis was not associated with inferior progression-free survival (PFS) or overall survival (OS), apart from inferior OS for patients with arterial events (aHR, 1.53; 95% CI, 1.12-2.08) in Myeloma XI. The Myeloma XI trial protocol incorporated International Myeloma Working Group (IMWG) thrombosis prevention recommendations and compared with Myeloma IX, more patients received thromboprophylaxis (80.5% vs 22.3%) with lower rates of VTE for identical regimens (CTD, 13.2% vs 16.1%; CTDa, 10.7% vs 16.0%). However, thrombosis remained frequent in spite of IMWG-guided thromboprophylaxis, suggesting that new approaches are needed.
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Mellish, Martha, Kasadee Allan und Bronwyn Crane. „Effects of sunlight hours and hormones on double ovulation, and singleton and twin pregnancies in mares“. Clinical Theriogenology 13, Nr. 2 (01.06.2021): 81–84. http://dx.doi.org/10.58292/ct.v13.9356.
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Equine twin pregnancies are almost exclusively dizygotic, without the application of advanced reproductive technologies, requiring 2ovulations in 1 estrous cycle. Breeding records were used to determine the effects of sunlight hours, prostaglandin F2α, human chorionicgonadotropin, deslorelin (a gonadotropin releasing hormone agonist), and progesterone and estradiol on double ovulation rates,and singleton and twin pregnancy rates. Breeding records of mares (n = 267) and their estrous cycles (n = 914) were analysed. Doubleovulations occurred in 10.5% (96/914) of estrous cycles. Twin pregnancies were observed in 42.7% (38/89) of mares that had doubleovulations. Overall, per estrous cycle pregnancy rate was 47.2% (405/858) and twin pregnancies was 4.4% (38/858). Double ovulationshad higher (p < 0.001) per cycle singleton pregnancy rate (69.7%; 62/89) than 1-ovulation cycles (44.6%; 343/769). Deslorelinincreased (p < 0.05; OR =1.24 95% CI) double ovulations and human chorionic gonadotropin tended (p = 0.089; OR =1.68; 95%CI) to increase double ovulations. Deslorelin use resulted in an odds ratio of 2.47 for a positive pregnancy (either singleton or twin)diagnosis compared to cycles without deslorelin use. None of the factors examined had a substantial impact on twin pregnancy rates.
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Tsuchiya, Norihiko, Yoshiaki Yamamoto, Hirotsugu Uemura, Hiro-Omi Kanayama, Masatoshi Eto, Hideaki Miyake, Thomas Powles et al. „Avelumab (Ave) first-line (1L) maintenance plus best supportive care (BSC) versus BSC alone for advanced urothelial carcinoma (UC): JAVELIN Bladder 100 Japanese subgroup analysis.“ Journal of Clinical Oncology 39, Nr. 6_suppl (20.02.2021): 425. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.425.
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425 Background: A randomized phase III trial (JAVELIN Bladder 100; NCT02603432) to investigate avelumab (anti–PD-L1) as 1L maintenance therapy in patients with advanced UC met its primary objective, demonstrating significantly prolonged overall survival (OS) with Ave + BSC vs BSC alone in all randomized patients and in patients with PD-L1+ tumors. We report efficacy and safety in Japanese patients enrolled in this study. Methods: Eligible patients with unresectable locally advanced or metastatic UC that had not progressed with 4-6 cycles of gemcitabine with either cisplatin or carboplatin were randomized 1:1 to receive maintenance Ave (10 mg/kg IV every 2 weeks) + BSC or BSC alone, stratified by best response to 1L chemotherapy (complete/partial response vs stable disease) and by visceral vs nonvisceral disease when initiating 1L chemotherapy. The primary endpoint was OS, assessed from randomization in all randomized patients and in patients with PD-L1+ tumors (Ventana SP263 assay). Secondary endpoints included progression-free survival (PFS) per blinded independent central review and safety. Results: Japanese patients (n=73) were randomized to receive Ave + BSC (n=36) or BSC alone (n=37); 52.8% vs 62.2% had PD-L1+ tumors, respectively. Median OS (95% CI) was 24.7 months (18.2-not estimable [NE]) with Ave + BSC vs 18.7 months (12.8-33.0) with BSC alone (HR, 0.81 [95% CI; 0.409-1.585]) in all randomized patients and 18.6 months (9.4-NE) with Ave + BSC vs 19.4 months (11.7-33.0) with BSC alone (HR, 1.00 [95% CI, 0.413-2.412]) in patients with PD-L1+ tumors. Median PFS (95% CI) was 5.6 months (1.9-9.4) with Ave + BSC vs 1.9 months (1.9-3.8) with BSC alone (HR, 0.63 [95% CI, 0.358-1.113]) in all randomized patients and 5.6 months (1.8-11.2) with Ave + BSC vs 1.9 months (1.9-3.8) with BSC alone (HR, 0.62 [95% CI, 0.298-1.301]) in patients with PD-L1+ tumors. The most common treatment-emergent adverse events (all grade; grade ≥3) in the Ave + BSC arm were pyrexia (10 [27.8%]; 0), nasopharyngitis (7 [19.4%]; 0), and anemia (7 [19.4%]; 4 [11.1%]). Conclusions: Ave 1L maintenance + BSC was efficacious and tolerable in Japanese patients with advanced UC, and results were generally consistent with those in the overall population. Clinical trial information: NCT02603432.
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Schulz, Victor C., Pedro S. C. de Magalhaes, Camila C. Carneiro, Julia I. T. da Silva, Vivian N. Silva, Vanessa V. Guesser, Juliana Safanelli et al. „Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country“. Current Neurovascular Research 17, Nr. 4 (14.12.2020): 361–75. http://dx.doi.org/10.2174/1567202617666200521083132.
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Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.
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Jin, Linda, Bradley Krasnick, Jesse Davidson, Cecilia Grace Ethun, Timothy M. Pawlik, George A. Poultsides, Thuy Tran et al. „The effect of postoperative morbidity on long-term survival after curative resection for extra-hepatic biliary tumors: A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.“ Journal of Clinical Oncology 34, Nr. 4_suppl (01.02.2016): 435. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.435.
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435 Background: Surgical resection is the cornerstone of curative therapy for extrahepatic biliary tumors (EHBTs) Postoperative complications (POCs) can negatively impact survival after oncologic resection. We evaluated the impact of POCs on survival after resection of EHBTs. Methods: We analyzed 914 patients from ten institutions of the U.S. Extrahepatic Biliary Malignancy Consortium who underwent curative resection for gallbladder adenocarcinoma (n=389), hilar (n=295) and distal (n=294) cholangiocarcinoma between 1998 and 2015. POCs were graded using the modified Clavien-Dindo system. Overall survival (OS) probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 20 months. The median age was 66 years, and the overall complication rate was 54%. Complication rates were significantly higher in patients with distal or hilar cholangiocarcinoma (62%) when compared with gallbladder cancer (41%, p<0.001). For all cancer types, patients who experienced POCs had lower 5-year OS when compared with those who did not (18% vs 28%, p<0.001). On multivariate Cox regression, POC remained an independent predictor for decreased OS (HR 1.5, 95% CI 1.3-1.9, p<0.001; Table). Among patients who experienced POCs, survival did not differ by greatest Clavien grade of complication experienced (p=0.89), however patients who had 2 or more POCs did have decreased long term survival when compared with patients with only a single POC (HR 1.5, 95% CI 1.2-1.8, p=0.001). Conclusions: POCs adversely affect long-term outcomes after curative resection for extra-hepatic biliary tumors. While any complication grade did not have a significant impact on long-term survival, increasing number of POCs did significantly worsen the prognosis for OS. [Table: see text]
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Patel, Kiran, Brenda Diergaarde, Adam Brufsky, Rachel Catherine Jankowitz, Barry C. Lembersky, Priya Rastogi und Shannon Leigh Huggins-Puhalla. „Incidence of febrile neutropenia with use of docetaxel plus cyclophosphamide (TC) for breast cancer.“ Journal of Clinical Oncology 35, Nr. 15_suppl (20.05.2017): e12073-e12073. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12073.
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e12073 Background: Incidence of febrile neutropenia (FN) is reported as 5% in breast cancer patients receiving TC (Jones et al., JCO 2006), which would not justify the usage of prophylactic granulocyte colony stimulating factors (G-CSF). We previously showed that the incidence of FN may be as high as 23% in a small study. (N = 130, Soni et al., ASCO 2011). In the current study, we determined the incidence of FN in a larger cohort (N = 415), and evaluated the usage of G-CSF and its relation to FN, age, stage, and hormonal status. Methods: We retrospectively reviewed the electronic medical records from patients diagnosed with breast cancer who received at least one standard dose cycle of adjuvant TC between 2010-2016 at a university-based breast oncology practice. Chi-square or Fisher’s exact tests were used to assess differences between groups. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression models. Results: We identified in total 415 patients who received adjuvant TC. Median age at diagnosis was 58 (range: 25-86), the majority had stage I or II (N = 382; 92.1%) disease, and 315 (75.9%) were ER+, 277 (66.8%) PR+, 42 (10.1%) HER2+, 22 (5.3%) triple-positive, and 81 (19.5%) triple-negative. Prophylactic G-CSF was utilized in 247 patients (59.5%), and unknown for 43 (10.4%). Overall 39 (9.4%) patients experienced febrile neutropenia. Incidence of FN among those receiving G-CSF was 4.5% versus 17.6% among those who did not (p < 0.001). Use of G-CSF significantly lowered risk of FN, OR (95%CI): 0.20 (0.10-0.43) adjusted for age at diagnosis and stage. Use of G-CSF on incidence of FN did not differ significantly by age, stage, or hormonal status. Conclusions: Our data confirms a high rate of FN in patients receiving TC without G-CSF prophylaxis. Our institutional high rate of G-CSF use ( > 50%) reduced the incidence of FN to 4.5% and the observed significant difference in FN incidence between the non G-CSF group and G-CSF group suggests that prophylaxis may be considered when administering TC. Age, stage, and hormonal status do not seem to affect the usage of G-CSF or incidence of FN in our population.
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Bando, H., T. Yoshino, E. Shinozaki, S. Yuki, T. Nishina, S. Kadowaki, K. Yamazaki, K. Tsuchihara, S. Fujii und T. Yamanaka. „Clinical outcome in patients with metastatic colorectal cancer harboring KRAS p.G13D mutation treated with cetuximab.“ Journal of Clinical Oncology 29, Nr. 4_suppl (01.02.2011): 448. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.448.
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448 Background: Metastatic colorectal cancer patients with KRAS codon 12 or 13 mutated tumors are presently excluded from treatment with cetuximab (Cmab). On the other hand, a few patients who have mutated KRAS status occasionally respond to Cmab. The tumors of those patients predominantly had codon 13 mutation, and all codon 13 responder have mutation of p.G13D. We now compared the efficacy of Cmab among patients with p.G13D- mutant, other KRAS mutant and KRAS wild-type colorectal cancer. Methods: The patients from 9 Japanese institutions were retrospectively collected and analyzed. All patients were refractory to fluoropyrimidine, oxaliplatin and irinotecan, and were treated with Cmab and irinotecan combination regimen. Response rate (RR), progression-free survival (PFS) and overall survival (OS) were calculated respectively according to KRAS status. Results: Ninety four patients were treated with combination therapy. Among 94 cases, 7 cases were p.G13D-mutant KRAS, 23 cases were other mutant KRAS and 63 cases were wild-type KRAS. Baseline characteristics by each subset were well-balanced. While one partial response (PR) and 4 stable diseases (SD) cases were found in 7 p.G13D-mutated cases, no PR was found in other KRAS mutated cases. Median PFS of the patients with p.G13D-mutant, other KRAS mutant and KRAS wild-type were 4.5 months (95%CI 1.7-), 2.3 months (95%CI 1.9-4.3), 4.6 months (95%CI 3.5-6.5) respectively. And median OS of the patients with p.G13D- mutant, other KRAS mutant and KRAS wild-type were 9.3months (95%CI 8.5- 11.8), 7.4 months (95%CI 4.5-9.4), 12.2 months (95%CI 8.7-19.8) respectively. Although statistical significance was not found between the two mutated groups, there are trends that the patients with p.G13D-mutant may have received better clinical benefits from Cmab than the patients with other KRAS mutant. Conclusions: Cmab may have therapeutic benefit in the patients with KRAS p.G13D-mutant colorectal cancer although further evaluation is warranted. No significant financial relationships to disclose.
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Belozorov, Alexei, Olga Fedets, Tatjana Chastii, Elena Milutina, Oksana Sokol, Ritsa Grigorova und Sergey Unuchko. „Chlamydia trachomatis infection positivity rates determined by nucleic acid amplification test in patients of hospitals in the northeastern region of Ukraine“. International Journal of STD & AIDS 28, Nr. 14 (05.06.2017): 1405–9. http://dx.doi.org/10.1177/0956462417709831.
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There are no accurate data regarding the prevalence of Chlamydia trachomatis infection in Ukraine. This study aims to estimate the prevalence in the northeastern region of the country through reviewing nucleic acid amplification test results in patients of medical institutions in the Kharkov region during 2014–2016. Samples from 6920 patients (5028 women and 1892 men) aged 12–76 years were tested. The overall positivity rate was 4.5% (95% CI 4.0–5.0): 3.9% (95% CI 3.4–4.5) in women and 6.1% (95% CI 5.1–7.3) in men. The highest prevalence was found in the 16–20 (8.5%, CI 6.3–11.4) and 21–25 (8.0%, CI 6.7–9.4) year age groups. The prevalence in men was higher than in women in all investigated groups. The results show the need for more attention to the prevention, diagnosis, and treatment of chlamydial infection in these age groups of women and men in this region.
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Kukreja, Janet Baack, Roger Li, Mohamed Seif, Xuemei Wang, Ashish M. Kamat, Colin P. N. Dinney, Louis L. Pisters und Neema Navai. „A comparison of pathologic and intermediate term oncologic outcomes following open and robotic radical cystectomy.“ Journal of Clinical Oncology 37, Nr. 7_suppl (01.03.2019): 440. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.440.
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440 Background: Conflicting data regarding the oncologic efficacy of robotic surgery has led to concerns for possible inferiority. Despite recent prospective results from the RAZOR trial demonstrating non-inferior progression free survival, results from another prospective randomized trial from Memorial Sloan Kettering suggests a possible difference in the pattern of recurrences. We examined our experience with both open (ORC) and robotic radical cystectomy (RRC) with the objective of establishing recurrence patterns and pathologic comparisons at a high volume tertiary referral center. Methods: We performed a retrospective cohort study at a high volume academic tertiary referral center for patients who underwent radical cystectomy (RC) for bladder cancer from 2005 to 2017. The surgical choice of RRC or ORC is based on provider preference. A multivariable analysis was carried out to determine factors predictive of recurrence free survival (RFS) and overall survival after RC. Analysis was done with SAS 9.4. Results: 1813 patients were identified, 10% underwent RRC and no difference in recurrence patterns were found compared to ORC. There was no difference in the severity of pathology distribution between the two cohorts. There was no difference in positive surgical margin status, 2.4% in ORC and 1.1% in RRC. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.5% in RRC. Shorter RFS was associated with younger age (HR 1.04, 95%CI 1.03-1.05, p<0.001), neoadjuvant chemotherapy (HR1.55 95%CI 1.32-1.82, p<0.001), higher pathologic stage (stage T4 HR 4.38, 95%CI 3.17-6.06, p<0.001), positive lymph nodes at RC (HR 1.82 95%CI 1.53-2.17, p<0.001) and positive surgical margins (HR 1.50 95%CI 1.19-1.89, p<0.001). At a median follow up of 60 months neither progression free or overall survival for ORC compared to RRC was significantly different. Conclusions: The data from this study supports continued use of RRC as a safe oncologic procedure with similar outcomes to ORC.
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Bender, Jacqueline L., Deb Feldman-Stewart, Christine Tong, Karen Lee, Michael Brundage, Howard Pai, John Robinson und Tony Panzarella. „Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study“. Journal of Medical Internet Research 21, Nr. 11 (19.11.2019): e14241. http://dx.doi.org/10.2196/14241.
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Background After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. Objective This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. Methods Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. Results A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%). Conclusions Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men’s confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects.
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Elimian, Kelly Osezele, Olaolu Aderinola, Jack Gibson, Puja Myles, Chinwe Lucia Ochu, Carina King, Tochi Okwor et al. „Assessing the capacity of symptom scores to predict COVID-19 positivity in Nigeria: a national derivation and validation cohort study“. BMJ Open 11, Nr. 9 (September 2021): e049699. http://dx.doi.org/10.1136/bmjopen-2021-049699.
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ObjectivesThis study aimed to develop and validate a symptom prediction tool for COVID-19 test positivity in Nigeria.DesignPredictive modelling study.SettingAll Nigeria States and the Federal Capital Territory.ParticipantsA cohort of 43 221 individuals within the national COVID-19 surveillance dataset from 27 February to 27 August 2020. Complete dataset was randomly split into two equal halves: derivation and validation datasets. Using the derivation dataset (n=21 477), backward multivariable logistic regression approach was used to identify symptoms positively associated with COVID-19 positivity (by real-time PCR) in children (≤17 years), adults (18–64 years) and elderly (≥65 years) patients separately.Outcome measuresWeighted statistical and clinical scores based on beta regression coefficients and clinicians’ judgements, respectively. Using the validation dataset (n=21 744), area under the receiver operating characteristic curve (AUROC) values were used to assess the predictive capacity of individual symptoms, unweighted score and the two weighted scores.ResultsOverall, 27.6% of children (4415/15 988), 34.6% of adults (9154/26 441) and 40.0% of elderly (317/792) that had been tested were positive for COVID-19. Best individual symptom predictor of COVID-19 positivity was loss of smell in children (AUROC 0.56, 95% CI 0.55 to 0.56), either fever or cough in adults (AUROC 0.57, 95% CI 0.56 to 0.58) and difficulty in breathing in the elderly (AUROC 0.53, 95% CI 0.48 to 0.58) patients. In children, adults and the elderly patients, all scoring approaches showed similar predictive performance.ConclusionsThe predictive capacity of various symptom scores for COVID-19 positivity was poor overall. However, the findings could serve as an advocacy tool for more investments in resources for capacity strengthening of molecular testing for COVID-19 in Nigeria.
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Wissmann, Bárbara, Lucas Franzoni, César Augusto Miorelli Campos, Tainara Gomes Vargas, Ana Luiza Ziulkoski, Edna Sayuri Suyenaga und Magda Susana Perassolo. „Patients’ perception and use of medicinal plants for chronic disease in a community from Rio Grande do Sul / Percepção dos pacientes e uso de plantas medicinais para doenças crônicas em comunidade do Rio Grande do Sul“. Brazilian Journal of Development 8, Nr. 5 (20.05.2022): 39589–608. http://dx.doi.org/10.34117/bjdv8n5-447.
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The popular use of medicinal plants to treat health problems is well known and disseminated from generation to generation, but little is known about toxicity and interactions. Therefore, this work aims to verify the perception about the use of medicinal plants for chronic patients in a community located in Rio Grande do Sul. A cross-sectional study was carried out with chronic diseases’ patients from the municipality of Novo Hamburgo, RS that are users of medicinal plants. Sociodemographic data, clinical characteristics and aspects related to the use of medicinal plants were evaluated for 100 users of medicinal plants, predominantly female (90%) and mean age was 54.8 years. Most have incomplete elementary education (55%) and 95% of those interviewed receive a monthly family income of 1 to 3 minimum wages. There were 318 citations of plant species, of which 63 were different types. The most used were chamomile (Matricaria chamomilla L, 9.4%), lemon grass [Cymbopogon citratus (DC.) Stapf, 8.4%), pennyroyal (Mentha pulegium L., 6.2%) and macela [Achyrocline satureioides (Lam.) DC., 5%]. Regarding the preparation method, 52% of the patients performed infusion, 39% decoction, 7% decoction and infusion and 2% consumed in the mate. Most of the results on the medicinal plants used are consistent with the findings in the literature and it is noticed that a great part of interviewees knows that, even being natural products, medicinal plants may be dangerous.
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Ozguroglu, Mustafa, Ajjai Shivaram Alva, Tibor Csőszi, Nobuaki Matsubara, Lajos Geczi, Susanna Y. Cheng, Yves Fradet et al. „Analysis of PFS2 by subsequent therapy in KEYNOTE-361: Pembrolizumab (pembro) plus chemotherapy (chemo) or pembro alone versus chemo as 1L therapy for advanced urothelial carcinoma (UC).“ Journal of Clinical Oncology 39, Nr. 6_suppl (20.02.2021): 448. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.448.
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448 Background: 1L pembro + chemo did not show statistically superior PFS and OS vs chemo for pts with advanced UC in the phase III KEYNOTE-361 study; OS for pembro vs chemo was not formally tested. We analyzed PFS2 (time from randomization to progressive disease [PD] on first subsequent therapy, or death from any cause, whichever occurs first) by study treatment and subsequent therapy in KEYNOTE-361 (NCT02853305) to determine the effects, if any, of therapy sequence on PFS2. Methods: PFS2 was estimated for pts in each treatment arm, who received any subsequent therapy including any anti–PD-(L)1, any therapy other than anti–PD-(L)1, or no therapy. These were exploratory analyses; no formal comparisons were done. Results: 1010 pts were randomized: 351 pts to receive pembro + chemo, 307 to pembro, and 352 to chemo. As of Apr 29, 2020, the median (range) time from randomization to data cutoff was 31.7 (22.0-42.3) mo. Subsequent therapy was received by 124/351 (35%), 126/307 (41%), and 215/352 (61%) pts in the pembro + chemo, pembro, and chemo arms, respectively. Subsequent anti–PD-(L)1 therapy was received by 169/352 (48%) pts in the chemo arm vs 23/351 (7%) in the pembro + chemo arm and 14/307 (5%) in the pembro arm. Of pts in the pembro arm who received subsequent therapy, >90% received 2L cisplatin-based or carboplatin-based treatment. Median (m) PFS2 (95% CI) for all pts by treatment arm was 14.1 mo (12.6-16.2) with pembro + chemo, 10.9 mo (9.5-12.9) with pembro, and 10.4 mo (9.8-11.2) with chemo. Across treatment arms, pts in the pembro + chemo arm had the longest mPFS2 with any subsequent therapy (14.5 mo [95% CI 13.1-16.6]) (Table). Pts in the pembro arm who received no subsequent therapy had a longer mPFS2 (12.9 mo [95% CI 8.1-17.9]) vs pts in the chemo arm who received no subsequent therapy (9.4 mo [95% CI 7.6-10.6]). Finally, pts treated with 1L pembro in the trial followed by 2L therapy other than anti−PD-(L)1 had comparable mPFS2 (10.2 mo [95% CI 8.6-12.1]) to pts treated with 1L chemo in the trial followed by 2L anti−PD-(L)1 (11.1 mo [95% CI 10.2-12.9]). Conclusions: In this exploratory analysis, treatment sequence of chemo followed by anti−PD-(L)1 upon PD vs anti–PD-(L)1 followed by chemo upon PD did not appear to impact mPFS2. Among pts who did not receive 2L therapy, 1L pembro appeared to be associated with longer mPFS2 than chemo, potentially driven by long-term responders to pembro. Clinical trial information: NCT02853305 . [Table: see text]
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Rey Lopez, Juan Pablo, Klaus Gebel, Debbie Chia und Emmanuel Stamatakis. „Associations of vigorous physical activity with all-cause, cardiovascular and cancer mortality among 64 913 adults“. BMJ Open Sport & Exercise Medicine 5, Nr. 1 (August 2019): e000596. http://dx.doi.org/10.1136/bmjsem-2019-000596.
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BackgroundPhysical activity recommendations state that for the same energy expenditure, moderate-to-vigorous physical activities (MVPAs) produce similar health benefits. However, few epidemiological studies have tested this hypothesis.DesignWe examined whether, compared with moderate, vigorous activity was associated with larger mortality risk reductions.MethodsData from 11 cohorts of the Health Survey for England and the Scottish Health Survey, collected from 1994 to 2011 (mean (SD) follow-up, 9.0 (3.6) years). Adults aged ≥30 years reported MVPA and linkage to mortality records. Exposure was the proportion of self-reported weighted MVPA through vigorous activity. Outcomes were all-cause, cardiovascular disease (CVD) and cancer mortality.ResultsAmong 64 913 adult respondents (44% men, 56% women, mean (SD) age, 49.8 (13.6) years), there were 5064 deaths from all-causes, 1393 from CVD and 1602 from cancer during 435 743 person-years of follow-up. Compared with those who reported no vigorous physical activity, and holding constant the volume of weighted MVPA, vigorous activity was associated with additional reductions in mortality risk. For all-cause mortality, the adjusted HR was HR=0.84 (95% CI 0.71, 0.99) and HR=0.84 (95% CI 0.76, 0.94) among those who reported between >0% and<30%, or ≥30% of their activity as vigorous, respectively. For CVD and cancer mortality, point estimates showed similar beneficial associations yet CIs were wider and crossed unity.ConclusionVigorous activities were associated with larger reductions in mortality risk than activities of moderate intensity, but no evidence of dose–response effects was found.
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Negrao, Marcelo V., Wen-Hsing Wu, Colin R. Lindsay, Rafael Caparica, Vincent Prêtre, Yehrim Kang, Nydia Caro, Anna Farago, Fen Ye und Gilberto de Castro. „Abstract 918: Real-world clinical characteristics and treatment (tx) outcomes by co-mutation status in patients (pts) with KRAS G12C-mutated non-small cell lung cancer (NSCLC)“. Cancer Research 83, Nr. 7_Supplement (04.04.2023): 918. http://dx.doi.org/10.1158/1538-7445.am2023-918.
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Abstract Background: KRAS mutations occur in ~30% of NSCLC and KRAS G12C is the most common subtype (~40%). Co-mutations can impact NSCLC prognosis and tx response. Methods: This retrospective study used the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine clinico-genomic database (FH-FMI CGDB; January 1, 2011 to March 31, 2022). De-identified data originated from ~280 US cancer clinics (~800 sites of care). This study is based on tissue-based assay (FoundationOne CDx). Pts were aged ≥18 years; had KRAS G12C-mutated, advanced/metastatic NSCLC, and had received ≥1 line of tx, with 1L tx initiated after October 1, 2016. Pts were categorized by presence (m) or absence (wt) of single co-mutations in STK11, KEAP1, or TP53; pts with EGFR, ALK, ROS1, BRAF, MET, or NTRK alterations were excluded. Key endpoints included overall survival (OS) and real-world progression-free survival (rwPFS). Statistical methods included a univariate Cox hazard model. Results: Among 847 pts with KRAS G12C-mutated NSCLC, co-mutations of STK11 were seen in 24%, KEAP1 in 14%, and TP53 in 51%. Based on non-missing records (82%), low tumor mutational burden (<10 mut/Mb) was more frequent in the STK11m vs wt group (72% vs 55%; p<0.001), not significantly different in the KEAP1m vs wt group (53% vs 60%; p=0.145), and less frequent in pts with TP53m vs wt (50% vs 69%; p<0.001). Negative PD-L1 status (<1%) was more frequent in pts with STK11 (50% vs 18%; p<0.001) or KEAP1 (41% vs 23%; p<0.001) mutations, and less frequent in pts with TP53 mutations (15% vs 37%; p<0.001). STK11 or KEAP1 co-mutations were associated with shorter rwPFS and OS, particularly in pts treated with immunotherapy (IO)-based 1L tx (Table 1). TP53 status did not significantly impact pt outcomes in the 1L setting. Conclusions: In this real-world analysis, STK11 or KEAP1 co-mutations were associated with PD-L1-negative tumors and poor outcomes with IO-based tx in KRAS G12C-mutated NSCLC. Table 1. rwPFS and OS by co-mutation status, and OS by 1L treatment and co-mutation status rwPFS and OS by co-mutation status rwPFS All (N=846) STK11m (n=206) STK11wt (n=640) KEAP1m (n=121) KEAP1wt (n=725) TP53m (n=429) TP53wt (n=417) Median, months (95% CI) 5.0 (4.5-5.7) 4.0 (3.1-4.9) 5.6 (4.9-6.2) 3.8 (2.7-4.8) 5.6 (4.7-6.2) 5.3 (4.6-6.1) 4.7 (4.0-5.7) HR (95% CI); p value - 1.38 (1.16-1.64); <0.001 1.46 (1.18-1.80); <0.001 0.87 (0.75-1.01); 0.07 OS All (N=847) STK11m (n=206) STK11wt (n=641) KEAP1m (n=121) KEAP1wt (n=726) TP53m (n=429) TP53wt (n=418) Median, months (95% CI) 11.9 (10.2-14.3) 9.4 (7.2-13.8) 12.4 (10.8-15.0) 7.6 (5.4-9.4) 13.5 (11.0-15.1) 11.0 (9.2-14.4) 12.7 (10.4-15.3) HR (95% CI); p value - 1.40 (1.15-1.70); <0.001 1.59 (1.26-2.00); <0.001 0.98 (0.83-1.17); 0.85 OS by 1L treatment and co-mutation status IO + chemotherapy STK11m (n=106) STK11wt (n=228) KEAP1m (n=53) KEAP1wt (n=281) TP53m (n=162) TP53wt (n=172) Median, months (95% CI) 6.9 (4.5-9.4) 11.3 (9.0-14.8) 7.9 (4.5-10.3) 10.2 (7.7-12.9) 9.3 (6.6-11.9) 10.9 (7.2-14.0) HR (95% CI); p value 1.75 (1.33-2.31); <0.0001 1.60 (1.13-2.26); 0.01 1.04 (0.80-1.36); 0.75 IO monotherapy STK11m (n=33) STK11wt (n=181) KEAP1m (n=29) KEAP1wt (n=185) TP53m (n=111) TP53wt (n=103) Median, months (95% CI) 9.7 (2.8-16.9) 16.1 (10.7-23.3) 5.7 (3.9-14.3) 16.6 (10.8-23.0) 15.1 (9.1-22.4) 14.6 (8.9-23.0) HR (95% CI); p value 1.54 (0.97-2.46); 0.07 1.81 (1.12-2.90); 0.01 0.96 (0.68-1.37); 0.83 Chemotherapy only STK11m (n=56) STK11wt (n=188) KEAP1m (n=28) KEAP1wt (n=216) TP53m (n=130) TP53wt (n=114) Median, months (95% CI) 18.6 (10.2-22.8) 13.5 (9.5-15.3) 7.8 (5.0-17.4) 14.5 (11.1-16.3) 12.0 (8.9-16.0) 15.0 (11.1-19.5) HR (95% CI); p value 0.84 (0.57-1.25); 0.40 1.31 (0.82-2.10); 0.26 1.12 (0.81-1.54); 0.49 CI, confidence interval; HR, hazard ratio. Citation Format: Marcelo V. Negrao, Wen-Hsing Wu, Colin R. Lindsay, Rafael Caparica, Vincent Prêtre, Yehrim Kang, Nydia Caro, Anna Farago, Fen Ye, Gilberto de Castro Jr. Real-world clinical characteristics and treatment (tx) outcomes by co-mutation status in patients (pts) with KRAS G12C-mutated non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 918.
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Gafton, Georgiy, Valentin Anisimov, Dmitriy Matsko, Aleksandr Ivantsov, Ivan Gafton und M. Myasnyankin. „LONG-TERM RESULTS OF TREATMENT OF PATIENTS WITH SUBUNGUAL MELANOMA“. Problems in oncology 63, Nr. 3 (01.03.2017): 479–85. http://dx.doi.org/10.37469/0507-3758-2017-63-3-479-485.
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At the N.N. Petrov Research Institute of Oncology from 1986 to 2015 there were performed 445 radical operations for skin melanoma of upper and lower extremities in patients aged 18 to 87 years. The present study analyzed data of 40 patients with morphologically confirmed diagnosis of “subungual melanoma” (SM). Long-term results and causes of death were evaluated in all operated patients. A 1-year survival rate of SM patients, whatever stage of disease was 90%, a 5-year overall survival rate - 47%, while only 20% of patients have survived a 10-year line. Overall survival median was 55 ± 9.4 months (95% CI, 36.4-73.5). The probability of death of radically operated SM patients in the next 5 years after surgical treatment from co-morbidities did not exceed 10%. SM patients had the worst prognosis as compared with patients with skin melanoma of upper and lower limbs (p = 0,0001).
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Martinez-Gomez, David, Irene Esteban-Cornejo, Esther Lopez-Garcia, Esther García-Esquinas, Kabir P. Sadarangani, Oscar L. Veiga und Fernando Rodriguez-Artalejo. „Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults“. British Journal of Sports Medicine 54, Nr. 4 (15.12.2018): 238–44. http://dx.doi.org/10.1136/bjsports-2018-099740.
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ObjectivesWe examined the dose–response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan.MethodsThis study included 1 98 919 participants, aged 18–97 years, free of CVD, cancer and diabetes at baseline (1997–2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive’ (0 metabolic equivalent of task (MET)-h/week), ‘lower insufficiently active’ (0.1–3.75 MET-h/week), ‘upper insufficiently active’ (3.75–7.49 MET-h/week), ‘active’ (7.5–14.99 MET-h/week) and ‘highly active’ (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders.ResultsDuring a mean follow-up of 6.0±4.5 years (range 0.5–19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts.ConclusionCompared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults.
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Cooper, Sue, Sarah Lewis, James G. Thornton, Neil Marlow, Kim Watts, John Britton, Matthew J. Grainge et al. „The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy – clinical effectiveness and safety until 2 years after delivery, with economic evaluation“. Health Technology Assessment 18, Nr. 54 (August 2014): 1–128. http://dx.doi.org/10.3310/hta18540.
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BackgroundSmoking during pregnancy causes many adverse pregnancy and birth outcomes. Nicotine replacement therapy (NRT) is effective for cessation outside pregnancy but efficacy and safety in pregnancy are unknown. We hypothesised that NRT would increase smoking cessation in pregnancy without adversely affecting infants.ObjectivesTo compare (1) at delivery, the clinical effectiveness and cost-effectiveness for achieving biochemically validated smoking cessation of NRT patches with placebo patches in pregnancy and (2) in infants at 2 years of age, the effects of maternal NRT patch use with placebo patch use in pregnancy on behaviour, development and disability.DesignRandomised, placebo-controlled, parallel-group trial and economic evaluation with follow-up at 4 weeks after randomisation, delivery and until infants were 2 years old. Randomisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio. Participants, site pharmacies and all study staff were blind to treatment allocation.SettingSeven antenatal hospitals in the Midlands and north-west England.ParticipantsWomen between 12 and 24 weeks’ gestation who smoked ≥ 10 cigarettes a day before and ≥ 5 during pregnancy, with an exhaled carbon monoxide (CO) reading of ≥ 8 parts per million (p.p.m.).InterventionsNRT patches (15 mg per 16 hours) or matched placebo as an 8-week course issued in two equal batches. A second batch was dispensed at 4 weeks to those abstinent from smoking.Main outcome measuresParticipants: self-reported, prolonged abstinence from smoking between a quit date and childbirth, validated at delivery by CO measurement and/or salivary cotinine (COT) (primary outcome). Infants, at 2 years: absence of impairment, defined as no disability or problems with behaviour and development. Economic: cost per ‘quitter’.ResultsOne thousand and fifty women enrolled (521 NRT, 529 placebo). There were 1010 live singleton births and 12 participants had live twins, while there were 14 fetal deaths and no birth data for 14 participants. Numbers of adverse pregnancy and birth outcomes were similar in trial groups, except for a greater number of caesarean deliveries in the NRT group. Smoking: all participants were included in the intention-to-treat (ITT) analyses; those lost to follow-up (7% for primary outcome) were assumed to be smoking. At 1 month after randomisation, the validated cessation rate was higher in the NRT group {21.3% vs. 11.7%, odds ratio [OR], [95% confidence interval (CI)] for cessation with NRT, 2.05 [1.46 to 2.88]}. At delivery, there was no difference between groups’ smoking cessation rates: 9.4% in the NRT and 7.6% in the placebo group [OR (95% CI), 1.26 (0.82 to 1.96)]. Infants: at 2 years, analyses were based on data from 888 out of 1010 (87.9%) singleton infants (including four postnatal infant deaths) [445/503 (88.5%) NRT, 443/507 (87.4%) placebo] and used multiple imputation. In the NRT group, 72.6% (323/445) had no impairment compared with 65.5% (290/443) in placebo (OR 1.40, 95% CI 1.05 to 1.86). The incremental cost-effectiveness ratio for NRT use was £4156 per quitter (£4926 including twins), but there was substantial uncertainty around these estimates.ConclusionsNicotine replacement therapy patches had no enduring, significant effect on smoking in pregnancy; however, 2-year-olds born to women who used NRT were more likely to have survived without any developmental impairment. Further studies should investigate the clinical effectiveness and safety of higher doses of NRT.Trial registrationCurrent Controlled Trials ISRCTN07249128.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 54. See the NIHR Journals Library programme website for further project information.
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Bruno Tongun, Mukunya, Tylleskar, Sebit, Tumwine und Ndeezi. „Determinants of Health Facility Utilization at Birth in South Sudan“. International Journal of Environmental Research and Public Health 16, Nr. 13 (09.07.2019): 2445. http://dx.doi.org/10.3390/ijerph16132445.
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South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2–35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.
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Kubanov, A. A., und E. V. Bogdanova. „Influence of age of onset of psoriasis on prevalence and clinical characteristics of psoriatic arthritis (according to the registry of patients with psoriasis)“. Rheumatology Science and Practice 60, Nr. 4 (06.09.2022): 445–49. http://dx.doi.org/10.47360/1995-4484-2022-445-449.
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Сlinical, immunological and genetic differences between patients with early and late onset psoriasis are reported. Comparative studies of clinical characteristics of psoriatic arthritis according to age of psoriasis onset (skin manifestation) are lacking.Aim – to compare the prevalence and clinical characteristics of psoriatic arthritis depending on age of psoriasis onset (skin manifestation) in patients included to the psoriasis patient registry of Russian Society of Dermatovenereologists and Cosmetologists.Materials and methods. Prevalence of psoriatic arthritis in 3,227 patients with psoriasis aged 18 years and older was calculated. Comparison of the clinical characteristics of psoriatic arthritis according to the age of onset of psoriasis was performed on 916 patients with psoriasis and psoriatic arthritis.The U-test was used to compare quantitative variables. To identify the association between qualitative variables, the χ2 test was used; odds ratio and 95% confidence interval were calculated, unadjusted and adjusted for other independent variables.Results. In the majority of patients (73%), psoriasis manifested before the age of 40. Psoriatic arthritis at the time of inclusion to the registry was diagnosed in 31.7% of patients with early onset psoriasis and in 19.5% of patients with late onset psoriasis (p=0.0005).The odds of having psoriatic arthritis were almost two times lower in patients with late onset psoriasis (p=0.0005). When adjusted for sex and age, the odds of having psoriatic arthritis among patients with late onset psoriasis became 4 times lower than in patients with early onset psoriasis (p=0.0005). However, when adjusted for sex and duration of psoriasis, the odds ratio lost its statistical significance.The axial involvement (32.1% vs 20.5%; p=0.003) and the involvement of foot joints (59.7% vs 51.5%; p=0.048) was more likely in patients with early onset psoriasis. The odds ratio for axial involvement was still statistically significant when adjusted for other independent variables.Conclusions. Age of onset of psoriasis before 40 years of age is associated with more frequent axial involvement in psoriatic arthritis.
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Dakhel, Ardwan, Gunnar Engström, Olle Melander, Stefan Acosta, Shahab Fatemi, Anders Gottsäter und Moncef Zarrouk. „Vasoactive Biomarkers Associated With Long-Term Incidence of Symptomatic Peripheral Arterial Disease and Mortality“. Angiology 72, Nr. 6 (28.01.2021): 550–55. http://dx.doi.org/10.1177/0003319720987739.
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We evaluated if plasma biomarkers can predict incident peripheral arterial disease (PAD) and mortality in a longitudinal cohort study. Men (n = 3618) and women (n = 1542) were included in the Malmö Preventive Project and underwent analysis of: C-terminal endothelin-1 (CT-proET-1), N-Terminal prosomatostatin (NT-proSST), midregional proatrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and copeptin. Participants were followed up for incident PAD and mortality until December 31, 2016. Median follow-up was 11.2 years (interquartile range 9.4-12.2). Cumulative incidence of PAD was 4.3% (221/5160), 4.5% in men (164/3618) and 3.7% in women (57/1542; P = .174). In an adjusted Cox proportional hazards regression model, higher CT-proET-1 (hazard ratio [HR] 1.8; 95% confidence interval [CI] 1.4-2.3), NT-proSST (HR 1.5; 95% CI 1.2-2.0), and MR-proANP (HR 1.7; 95% CI 1.3-2.3) were independently associated with incident PAD, and higher CT-proET-1 (HR 1.3; 95% CI 1.2-1.5), NT-proSST (HR 1.2; 95% CI 1.1-1.3), MR-proANP (HR 1.4; 95% CI 1.3-1.6), PCT (HR 1.1; 95% CI 1.0-1.2), and copeptin (HR 1.2; 95% CI 1.1-1.4) were independently associated with mortality. Increased levels of CT-proET-1, NT-proSST, and MR-proANP were independently associated with incident PAD, whereas all the vasoactive biomarkers were independently associated with mortality during follow-up.
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Hansen, E. „Flow-through (Bio)chemical sensors ? and ?, Elsevier, Amsterdam, 1994. Pages 331. Dfl 355.00 US$202.75. ISBN 0-444-89866-2“. Talanta 42, Nr. 4 (April 1995): 672. http://dx.doi.org/10.1016/0039-9140(95)90061-6.
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Matsuoka, Satoshi, Hidehiro Kaneko, Akira Okada, Akira Fukui, Yuichiro Yano, Hidetaka Itoh, Kojiro Morita et al. „Association between proteinuria and incident colorectal cancer: analysis of a nationwide population-based database“. BMJ Open 12, Nr. 4 (April 2022): e056250. http://dx.doi.org/10.1136/bmjopen-2021-056250.
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ObjectivesThis study aimed to assess whether adults with proteinuria were at a higher risk of incident colorectal cancer (CRC) than those without proteinuria using a large-scale population-based database.DesignA retrospective observational study.SettingThe JMDC Claims Database, an administrative health claims database, was used. Data were collected between 2005 and 2020.ParticipantsWe selected records of participants (n=3 543 705) who underwent health check-ups, including physical examinations, blood tests and urine dipstick tests. We excluded participants who were aged <20 years (n=25 577), had a history of CRC, colorectal disease, renal disease and renal replacement therapy (n=114 888), or had missing data on medications (n=170 145), cigarette smoking (n=14 835), alcohol consumption (n=366 414) or physical activity (n=106 550). Finally, we analysed 2 745 296 participants.Main outcome measuresThe primary outcome was CRC at any stage.ResultsParticipants were categorised as having no proteinuria (n=2 435 872), trace proteinuria (n=231 153) or positive proteinuria (n=78 271). Over a mean follow-up period of 1189±914 days, 10 615 CRC diagnoses were recorded. The incidence of CRC (95% CI) was lowest in participants without proteinuria (11.7; 95% CI, 11.5 to 11.9 per 10 000 person-years), followed by trace proteinuria (12.5; 95% CI, 11.7 to 13.3 per 10 000 person-years) and positive proteinuria (16.1; 95% CI, 14.6 to 17.7 per 10 000 person-years). After multivariable adjustment, compared with no proteinuria, HRs for incident CRC were 1.20 (95% CI, 1.12 to 1.29) and 1.23 (95% CI, 1.11 to 1.36) for trace and positive proteinuria, respectively. The association between proteinuria and incident CRC existed in participants after multiple imputations for missing data, with a follow-up period of ≥365 days, regardless of age, sex, obesity, hypertension, diabetes mellitus and estimated glomerular filtration rate.ConclusionsTrace and positive proteinuria were associated with a greater risk of incident CRC. Assessment of proteinuria could help identify individuals at an increased risk of CRC.
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Choe, Jeong Cheon, Kwang Soo Cha, Hye Yoon Jang, Jong Hyun Choi, Bo Won Kim, Jinhee Ahn, Jin Sup Park et al. „Outcomes of Acute Myocardial Infarction Patients Implanted With Biodegradable Polymer Biolimus-Eluting Stents Versus New-Generation Durable Polymer Drug-Eluting Stents: A Retrospective Analysis“. Angiology 68, Nr. 8 (20.11.2016): 698–706. http://dx.doi.org/10.1177/0003319716679339.
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We compared outcomes between biodegradable polymer biolimus-eluting stent (BP-BES) and new-generation durable polymer drug-eluting stent (DP-DES) implantations in patients with acute myocardial infarction (MI). Among 13472 patients with acute MI in a nationwide registry, 557 (64.8%) were in the BP-BES and 303 (35.2%) in the new-generation DP-DES group following coronary reperfusion. The occurrence of major adverse cardiac events (MACE; death, MI, revascularization) and stent thrombosis was compared. Major adverse cardiac events occurred in 53 (6.2%) patients and showed similar rates between the BP-BES and new-generation DP-DES groups (all: 6.6% vs 5.9%, P = .652; propensity score [PS] matched: n = 380, 6.3% vs 5.3%, P = .623). Stent thrombosis did not differ between groups (all: 0.3% vs 0.4%, P = .892; PS matched: 0.5% vs 0.5%, P = 1.000). Major adverse cardiac event-free survival was comparable between groups (all: 93.4% vs 94.1%, log-rank P = .357; PS matched: 93.7% vs 94.7%, log-rank P = .445). Biodegradable polymer biolimus-eluting stent was not associated with MACE (all: hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.75-3.74; P = 0.212; PS matched: HR, 1.05; 95% CI, 0.40-2.75; P = .915). In conclusion, in patients with acute MI, BP-BES was equivalent to the new-generation DP-DES in terms of outcomes.
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Hosomi, Sanae, Tetsuhisa Kitamura, Tomotaka Sobue, Ling Zha, Kosuke Kiyohara und Jun Oda. „Epidemiology and Outcome of Pediatric Out-of-Hospital Cardiac Arrest after Traffic Collision in Japan: A Population-Based Study“. Journal of Clinical Medicine 11, Nr. 3 (04.02.2022): 831. http://dx.doi.org/10.3390/jcm11030831.
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The epidemiological and clinical characteristics, treatments, and outcomes of patients with traumatic out-of-hospital cardiac arrests (OHCAs) following traffic collisions have not been adequately investigated in Japan. We analyzed the All-Japan Utstein Registry data of 918 pediatric patients aged <20 years with OHCAs following traffic collisions who were resuscitated by bystanders or emergency medical service personnel and were subsequently transported to hospitals between 2013 and 2019. Multiple logistic regression analysis was used to assess factors potentially associated with 1-month survival after OHCA. The 1-month survival rate was 3.3% (30/918), and the rate of neurologically favorable outcomes was 0.7% (60/918). The proportion of 1-month survival of all OHCAs after traffic collision origin did not significantly increase (from 1.9% (3/162) in 2013 to 4.5% (5/111) in 2019), and the adjusted odds ratio (OR) for a 1-year increment was 1.13 (95% confidence interval (CI) 0.93 to 1.37). In a multivariate analysis, ventricular fibrillation arrests and pulseless electrical activity (PEA) were significant predictors of 1-month outcome after OHCAs due to traffic collision. From a large OHCA registry in Japan, we demonstrated that 1-month survival after OHCAs due to traffic collision origin was approximately 3%, and some children even gained full recovery of neurological function.
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Srikajornlarp, Saowaluk, Montawatt Amnueypol, Prin Vathesatogkit, Pawin Numthavaj, Artit Ungkanont, Khanchit Likittanasombat, Oraluck Pattanaprateep, Pantep Angchaisuksiri und Kochawan Boonyawat. „Effectiveness and Safety of Direct Oral Anticoagulants in Thai Patients with Atrial Fibrillation: A Real-World Retrospective Cohort Study“. Clinical and Applied Thrombosis/Hemostasis 28 (Januar 2022): 107602962211300. http://dx.doi.org/10.1177/10760296221130058.
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Background Direct oral anticoagulants (DOACs) are commonly used to prevent stroke and systemic embolism in patients with atrial fibrillation (AF). However, studies into their effectiveness and safety in the Thai population have so far been limited. Objectives To study the effectiveness and safety of warfarin and DOACs among Thai AF patients Methods A retrospective cohort study was conducted on AF patients at Ramathibodi Hospital from 2013 to 2018. All patients were followed for at least 1 year. Relevant clinical information was collected and compared between AF patient groups receiving warfarin, dabigatran, rivaroxaban, and apixaban. The primary outcome was a composite of major bleeding, ischemic stroke, and systemic thromboembolism. The secondary outcomes were all-cause mortality and disease-specific mortality caused by major bleeding, ischemic stroke, and systemic thromboembolism. Results A total of 1680 AF patients were enrolled in the study (warfarin 1193, apixaban 140, dabigatran 193, rivaroxaban 114). The estimated incidence of composite outcome was 16% [95% CI, 14−18%] and 12.4% [95% CI, 9.4−15.3%] in the warfarin and DOAC group, respectively, given a number needed to treat of 28 [95% CI, 3−52]. Compared with warfarin, DOACs were associated with both lower rate of all-cause mortality (4.9% [22/447] vs 8% [98/1193]) and lower disease-specific mortality (0.4% [2/447] and 1% [12/1193]). Conclusions This study suggests DOACs were associated with a lower risk of major bleeding, ischemic stroke, and systemic thromboembolism compared to warfarin in Thai patients with AF. Patients receiving DOAC also had a lower rate of all-cause mortality and disease-specific mortality.
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Takahari, Daisuke, Narikazu Boku, Satoru Iwasa, Junki Mizusawa, Tadayoshi Hashimoto, Takaki Yoshikawa, Shigenori Kadowaki et al. „The new prognostic index of advanced gastric cancer using the data from JCOG1013.“ Journal of Clinical Oncology 41, Nr. 4_suppl (01.02.2023): 342. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.342.
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342 Background: We previously reported that performance status (PS) ≥1, no prior gastrectomy, number of metastatic sites ≥2, and high serum ALP level are poor prognosis factors and proposed a JCOG prognostic index by analyzing the data of advanced gastric cancer (AGC) patients enrolled in JCOG9912 (Takahari D et al. Oncologist 2014). Recently, Neutrocyte/ Lymphocyte Ratio (NLR) and diffuse type of cancer have also been reported to be prognostic factors of AGC. Methods: Prognostic factors were assessed in patients with AGC who enrolled in JCOG1013, the phase III study comparing docetaxel, cisplatin, and S-1 (DCS) versus cisplatin and S-1 (CS) in first-line treatment (Yamada Y et al. Lancet Gastroenterol Hepatol. 2019) was retrospectively evaluated using a Cox proportional regression model. The overall adequacy of risk prediction in the modified JCOG prognostic index and the original index were assessed by C-statistics. Results: Among 741 patients, 730 with all data for this analysis were selected. The median overall survival (OS) was 14.9 months (95% confidence interval [CI], 14.1–15.8). The median OS of the good (n=233), moderate (n=444), and poor (n=53) risk groups by the original JCOG index was 19.0, 14.2, and 9.1 months, respectively. The HRs compared with the good group were 1.59 [95% CI, 1.33–1.89; p < 0.0001] in the moderate group, and 2.47 [95% CI, 1.81–3.38; p < 0.0001] in the poor group with C-statistics of 0.572. In the multivariable analysis of 7 factors which showed p<0.1 in univariable analysis, PS ≥1 (hazard ratio [HR], 1.490; 95% CI, 1.264–1.755; p < 0.0001), diffuse type (HR, 1.337; 95% CI, 1.122–1.594; p = 0.012), number of metastatic sites ≥2 (HR, 1.256; 95% CI, 1.058–1.492; p = 0.0093), and NLR≥3.1 (HR, 1.539; 95% CI, 1.309–1.809; p < 0.0001) were significantly associated with worse prognosis, whereas no prior gastrectomy, peritoneal metastasis, and high serum ALP level were not. As the modified JCOG prognostic index, patients were classified into three groups according to the number of these four newly identified prognostic risk factors: good (no), moderate (1 or 2), and poor (3 or 4). Median OS of the good (n=221), moderate (n=441), and poor (n=68) risk groups was 20.6, 13.7, and 9.4 months, respectively. The HRs compared with the good group were 1.70 [95% CI, 1.42–2.03; p < 0.0001] in the moderate group, and 3.11 [95% CI, 2.33–4.14; p < 0.0001] in the poor group with C-statistics of 0.591. Three groups by the modified JCOG prognostic index also showed clear separation of OS in either subgroup of DCS or CS. Conclusions: Modified JCOG prognostic index, including NLR ≥3.1 and diffuse type instead of no prior gastrectomy and high serum ALP level, showed clear stratification of OS in JCOG1013.
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Chandan, Saurabh, Babu P. Mohan, Shahab R. Khan, Lena L. Kassab, Suresh Ponnada, Andrew Ofosu, Ishfaq Bhat, Shailender Singh und Douglas G. Adler. „Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients“. Endoscopy International Open 08, Nr. 11 (22.10.2020): E1664—E1672. http://dx.doi.org/10.1055/a-1236-3350.
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Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.
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Molla, Alemayehu, Atikilt Mengesha, Habtamu Derajew und Habtamu Kerebih. „Suicidal Ideation, Attempt, and Associated Factors among Patients with Tuberculosis in Ethiopia: A Cross-Sectional Study“. Psychiatry Journal 2019 (13.03.2019): 1–10. http://dx.doi.org/10.1155/2019/4149806.
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Background. Suicidal behaviors among people with tuberculosis are one of the commonest psychiatric emergencies that need a major public health concern. People with tuberculosis show suicidal ideation and attempt, which are problems to end life. In Ethiopia large numbers of people are affected by tuberculosis. Therefore, assessing suicide among patients with tuberculosis is important in implementing further interventions. Methods. An institutional based cross-sectional study was conducted among systematic random samples of 415 and face-to-face interview was used. Suicidal ideation and attempt were assessed by using suicidality module World Health Organization (WHO) composite International diagnostic interview (CIDI). Data was analyzed by using SPSS version 20. Bivariate and multivariate binary logistic analyses were done to identify associated factors to both suicidal ideation and attempt. P values less than 0.05 were considered statistically significant and strength of the association was presented by adjusted odds ratio with 95% C.I. Results. The prevalence of suicidal ideation and attempt among tuberculosis patients was 17.3% (95%CI, 13.7-20.6) and 7.5 %( 95%CI, 4.8-10.4), respectively. Being female (AOR=2.7, 95% CI 1.39, 5.23), no formal education (AOR=3.35, 95%CI 1.26, 9.91), extra-pulmonary tuberculosis (AOR=2.35, 95%CI 1.1, 4.98), depression (AOR=4.9, 95%CI, 2.56, 9.4), and perceived TB stigma (AOR=3.24, 95%CI, 1.64, 6.45) were statistically associated with suicidal ideation. Factors like being female (AOR=4.57, 95%CI, 1.7, 12.27), MDR-TB (AOR=3.06, 95%CI, 1.23, 7.57), comorbid HIV illness (AOR=6.67, 95%CI, 2.24, 19.94), and depression (AOR=4.75, 95%CI, 1.89, 11.91) were associated with suicidal attempt. Conclusion. Developing guidelines and training of health workers in TB clinics is important to screen and treat suicide among patients with tuberculosis.
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Naderemu, Paermanjiang, Jun-shi Zhang, Hai-ming Liu und Xin-juan Xu. „Correlation of 24-Hour Urinary Microalbumin and Atrial Arrhythmia in Patients With Essential Hypertension“. American Journal of Hypertension 35, Nr. 6 (01.06.2022): 572. http://dx.doi.org/10.1093/ajh/hpab180.
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Abstract Background To investigate the relationship between 24-hour urinary microalbumin (24h-UmAlb) and atrial arrhythmia in patients with essential hypertension (EH). Methods From March 2018 to January 2020, 917 EH patients at First Affiliated Hospital of Xinjiang Medical University were enrolled, and divided into nonatrial arrhythmia and atrial arrhythmia groups according to their 24-hour dynamic electrocardiography. The general clinical data and laboratory test parameters were compared. Results Compared with patients without atrial arrhythmia, the 24-UmAlb level was higher in patients with atrial arrhythmia (8.0, 5.0–19.7 vs. 7.5, 4.5–15.5 mg/24 hours, Z = −2.190, P < 0.05). Multivariate regression analysis showed that positive 24-UmAlb (odds ratio = 1.649, 95% confidence interval 1.065–2.554) and supine angiotensin II (odds ratio = 1.407, 95% confidence interval 1.034–1.914) were the risk factor for atrial arrhythmia in patients with EH after adjusted for left atrial diameter, age, course of hypertension, 24-hour systolic and diastolic blood pressure. Conclusions 24h-UmAlb is one of the risk factors for atrial arrhythmia in patients with EH.
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Røysted-Solås, Therese, Sven Gudmund Hinderaker, Lasantha Ubesekara und Vijitha De Silva. „Mothers at risk of postpartum depression in Sri Lanka: A population-based study using a validated screening tool“. PLOS ONE 17, Nr. 5 (25.05.2022): e0268748. http://dx.doi.org/10.1371/journal.pone.0268748.
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Background Postpartum depression is an important public health concern. The prevalence of postpartum depression is estimated to be 18% worldwide. The purpose of this study was to estimate the prevalence of mothers at risk of postpartum depression in Sri Lanka and to investigate its associated risk factors. Methods This was a cross-sectional study conducted among 975 mothers in Galle district, Sri Lanka. The prevalence of mothers at risk of postpartum depression was assessed using the Edinburgh Postpartum Depression scale (EPDS) which has been validated for screening for mothers at risk of postpartum depression in Sri Lanka with a cut-off score 9 or more. Prevalence was estimated using a cut-off 9 or more, 10 or more, 11 or more and 12 or more to assess the difference in prevalence using unvalidated cut-offs for screening. Data from routine records on pregnancy, delivery and postnatal care was collected to investigate possible predictors of EPDS score 9 or more (risk of postpartum depression). Univariate and multivariable logistic regressions were performed to identify risk factors for EPDS score 9 or more (risk of postpartum depression). Results The prevalence of mothers with EPDS score 9 or more was found to be 9.4% (95%CI: 7.8–11.4); EPDS score 10 or more was 5.6% (95%CI: 4.4–7.3). EPDS score 9 or more (risk of postpartum depression) was associated with the following risk factors: Former history of mental illness (aOR 32.9, 95%CI: 7.9–136.2), high maternal age 30–39 (aOR 2.2, 95%CI: 1.3–3.8), BMI 25.0–29.9 (aOR 2.6, 95%CI: 1.5–4.5), hypertension (aOR 3.6, 95%CI: 1.2–10.9) and newborn death (aOR 28.9, 95%CI: 4.5–185.1). One in five women reported thoughts of self-harm. Conclusion Around one in ten mothers in Sri Lanka experience symptoms of postpartum depression, highest risk among mothers who reported former history of mental illness and newborn death. The prevalence estimates were lower with a higher cut-off for screening and this highlights the importance of using the validated cut-off for screening in future studies on postpartum depression in Sri Lanka. Mothers at increased risk should be identified in antenatal care and are important targets of referral.
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Sánchez Macarro, Maravillas, Vicente Ávila-Gandía, Silvia Pérez-Piñero, Fernando Cánovas, Ana María García-Muñoz, María Salud Abellán-Ruiz, Desirée Victoria-Montesinos et al. „Antioxidant Effect of a Probiotic Product on a Model of Oxidative Stress Induced by High-Intensity and Duration Physical Exercise“. Antioxidants 10, Nr. 2 (22.02.2021): 323. http://dx.doi.org/10.3390/antiox10020323.
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This randomized double-blind and controlled single-center clinical trial was designed to evaluate the effect of a 6-week intake of a probiotic product (1 capsule/day) vs. a placebo on an oxidative stress model of physical exercise (high intensity and duration) in male cyclists (probiotic group, n = 22; placebo, n = 21). This probiotic included three lyophilized strains (Bifidobacterium longum CECT 7347, Lactobacillus casei CECT 9104, and Lactobacillus rhamnosus CECT 8361). Study variables were urinary isoprostane, serum malondialdehyde (MDA), serum oxidized low-density lipoprotein (Ox-LDL), urinary 8-hydroxy-2′-deoxiguanosine (8-OHdG), serum protein carbonyl, serum glutathione peroxidase (GPx), and serum superoxide dismutase (SOD). At 6 weeks, as compared with baseline, significant differences in 8-OHdG (Δ mean difference −10.9 (95% CI −14.5 to −7.3); p < 0.001), MDA (Δ mean difference −207.6 (95% CI −349.1 to −66.1; p < 0.05), and Ox-LDL (Δ mean difference −122.5 (95% CI −240 to −4.5); p < 0.05) were found in the probiotic group only. Serum GPx did not increase in the probiotic group, whereas the mean difference was significant in the placebo group (477.8 (95% CI 112.5 to 843.2); p < 0.05). These findings suggest an antioxidant effect of this probiotic on underlying interacting oxidative stress mechanisms and their modulation in healthy subjects. The study was registered in ClinicalTrials.gov (NCT03798821).
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Zutshi, Anita, Jayasree Santhosh, Julie Sheikh, Fareeha Naeem, Ahmed Al-Hamedi, Shahla Khan und Eishthiag Al-Said. „Implications of Early Pregnancy Obesity on Maternal, Fetal and Neonatal Health: Retrospective cohort study from Oman“. Sultan Qaboos University Medical Journal [SQUMJ] 18, Nr. 1 (04.04.2018): 47. http://dx.doi.org/10.18295/squmj.2018.18.01.008.
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Objectives: This study aimed to determine the prevalence of early pregnancy obesity among Omani women and to review maternal antenatal complications, intrapartum and postpartum events and neonatal complications among such women in comparison to women of normal weight. Methods: This retrospective cohort study included 2,652 pregnant Omani women who delivered at the Royal Hospital, Muscat, Oman, between November 2011 and April 2012. The patients’ electronic medical records were reviewed for antenatal, intrapartum and postpartum data. Body mass index was measured during the first trimester (≤12 gestational weeks) and classified according to the World Health Organization categories. Maternal and neonatal complications were compared between obese women and those of normal weight. Obstetric outcomes in uncomplicated pregnancies were also compared. Results: In the study cohort, there were 901 (34%) obese women and 912 (34.4%) women of normal weight; of these, 440 (48.8%) and 672 (73.7%) had uncomplicated pregnancies, respectively. Obese women had a significantly increased incidence of gestational diabetes (relative risk [RR]: 2.23; 95% confidence interval [CI]: 1.70–2.92; P <0.01), gestational hypertension (RR: 3.04; 95% CI: 1.63–5.65; P <0.01), Caesarean delivery (RR: 1.48; 95% CI: 1.08–2.03; P <0.01), postpartum haemorrhage (RR: 2.10; 95% CI: 1.11–4.10; P = 0.01) and fetal macrosomia (RR: 2.71; 95% CI: 1.21–6.09; P <0.01). Conclusion: Approximately one-third of the studied Omani women were obese. These women had a significantly increased risk of various maternal antenatal complications, intrapartum and postpartum events and neonatal complications.
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Lam, Tai Hing, Mohsen Janghorbani, Susan Fan und Richard Fielding. „Voluntary HIV antibody testing amongst youth in Hong Kong“. International Journal of STD & AIDS 14, Nr. 2 (01.02.2003): 132–38. http://dx.doi.org/10.1258/095646203321156917.
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We performed a study to estimate the prevalence of and factors associated with human immunodeficiency virus (HIV) antibody-testing behaviour among youth in Hong Kong. It was a population-based cross-sectional study. Questions on HIV testing were asked as part of a youth sexuality study conducted in July to December 1996 among young adults in Hong Kong. A total of 517 (53.6%) males and 447 (46.4%) females aged 17 to 28 years completed an anonymous structured self-administered questionnaire. Respondents had good knowledge about correct modes of HIV transmission and prevention. 9.4% (95% confidence interval [CI]: 7.0, 12.3) of males and 6.4% (95% CI: 4.3, 9.1) of females had been tested for HIV through blood donation. Excluding blood donation, 3.7% (95% CI: 2.2, 5.7) of males and 3.6% (95% CI: 2.1, 5.9) of females had been tested (voluntary testing). 47.5% (95% CI: 44.4, 50.7) of subjects reported at least one major risk factor for HIV infection. In multivariate analyses, factors independently associated with both voluntary HIV testing and HIV testing by blood donation were age and having had sex with multiple partners. A higher educational level was a predictor of HIV testing by blood donation. Self-assessment of having sufficient sex education was also significantly associated with voluntary HIV testing. HIV testing is not widespread in Hong Kong and those at risk are more likely to have been tested. It is of concern, however, that many of those reporting risk factors have not been tested.
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Grant, Rebecca, Olivier Flechelles, Narcisse Elenga, Benoît Tressières, Stanie Gaete, Jean-Christophe Hebert, Bruno Schaub et al. „Consequences of In Utero Zika Virus Exposure and Adverse Pregnancy and Early Childhood Outcomes: A Prospective Cohort Study“. Viruses 14, Nr. 12 (10.12.2022): 2755. http://dx.doi.org/10.3390/v14122755.
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We aimed to describe adverse pregnancy outcomes among women who had symptomatic, RT-PCR-confirmed ZIKV infection and early childhood outcomes among their infants. We enrolled pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection in a prospective cohort study, and their infants in a prospective pediatric cohort study. We defined adverse pregnancy and early childhood outcomes based on selected neurologic, ophthalmologic, auditory, musculoskeletal, and anthropometric abnormalities. We used RT-PCR and serologic tests to determine the ZIKV infection status of the child. Between 10 March and 24 November 2016, we enrolled 546 pregnant women with RT-PCR-confirmed ZIKV infection. The overall risk of adverse pregnancy and early childhood outcomes possibly related to in utero ZIKV exposure was 15.7% (95% CI: 12.8–19.0), distributed as follows: 3.6% (95% CI: 2.3–5.6) severe sequelae or fatality; 2.7% (95% CI: 1.6–4.5) major abnormalities; 9.4% (95% CI:7.1–12.2) mild abnormalities. The risk of severe sequelae or fatality was higher when ZIKV infection occurred during the first trimester (7.0%), compared to the second (2.7%) or third trimester (1.4%) (p = 0.02). Among the infants for whom ZIKV infection status could be determined, the vertical transmission rate was 3.0% (5/167) (95% CI: 1.1–7.2). Among pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection, severe or major pregnancy or early childhood outcomes were present in 6.3% of fetuses and infants. Severe outcomes occurred more frequently in fetuses and infants whose mothers had been infected in the first trimester.
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Shephard, Elizabeth A., Molly AL Parkinson und William T. Hamilton. „Recognising laryngeal cancer in primary care: a large case–control study using electronic records“. British Journal of General Practice 69, Nr. 679 (28.01.2019): e127-e133. http://dx.doi.org/10.3399/bjgp19x700997.
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BackgroundOver 1700 people are diagnosed with laryngeal cancer annually in England. Current National Institute for Health and Care Excellence (NICE) guidelines on referral for suspected laryngeal cancer were based on clinical consensus, in the absence of primary care studies.AimTo identify and quantify the primary care features of laryngeal cancer.Design and settingMatched case–control study of patients aged ≥40 years using data from the UK’s Clinical Practice Research Datalink.MethodClinical features of laryngeal cancer with which patients had presented to their GP in the year before diagnosis were identified and their association with cancer was assessed using conditional logistic regression. Positive predictive values (PPVs) for each clinical feature were calculated for the consulting population aged >60 years.ResultsIn total, 806 patients diagnosed with laryngeal cancer between 2000 and 2009 were studied, together with 3559 age-, sex-, and practice-matched controls. Ten features were significantly associated with laryngeal cancer: hoarseness odds ratio [OR] 904 (95% confidence interval [CI] = 277 to 2945); sore throat, first attendance OR 6.2 (95% CI = 3.7 to 10); sore throat, re-attendance OR 7.7 (95% CI = 2.6 to 23); dysphagia OR 6.5 (95% CI = 2.7 to 16); otalgia OR 5.0 (95% CI = 1.9 to 13); dyspnoea, re-attendance OR 4.7 (95% CI = 1.9 to 12); mouth symptoms OR 4.7 (95% CI = 1.8 to 12); recurrent chest infection OR 4.5 (95% CI = 2.4 to 8.5); insomnia OR 2.7 (95% CI = 1.3 to 5.6); and raised inflammatory markers OR 2.5 (95% CI = 1.5 to 4.1). All P-values were <0.01. Hoarseness had the highest individual PPV of 2.7%. Symptom combinations currently not included in NICE guidance were sore throat plus either dysphagia, dyspnoea, or otalgia, for which PPVs were >5%.ConclusionThese results expand current NICE guidance by identifying new symptom combinations that are associated with laryngeal cancer; they may help GPs to select more appropriate patients for referral.
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Rodseth, Reitze N., Bruce M. Biccard, Rong Chu, Giovana A. Lurati Buse, Lehana Thabane, Ameet Bakhai, Daniel Bolliger et al. „Postoperative B-type Natriuretic Peptide for Prediction of Major Cardiac Events in Patients Undergoing Noncardiac Surgery“. Anesthesiology 119, Nr. 2 (01.08.2013): 270–83. http://dx.doi.org/10.1097/aln.0b013e31829083f1.
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Abstract Background: It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery. Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more. Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64–0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77–0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74–7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29–7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32–254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55–75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58–4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67–86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05–1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0–9.34; P = 0.022). Patients with BNP values of 0–250, greater than 250–400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0–300, greater than 300–900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively. Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.
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Kaur-Knudsen, Diljit, Stig E. Bojesen, Anne Tybjærg-Hansen und Børge G. Nordestgaard. „Nicotinic Acetylcholine Receptor Polymorphism, Smoking Behavior, and Tobacco-Related Cancer and Lung and Cardiovascular Diseases: A Cohort Study“. Journal of Clinical Oncology 29, Nr. 21 (20.07.2011): 2875–82. http://dx.doi.org/10.1200/jco.2010.32.9870.
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Purpose We examined the associations between the nicotinic acetylcholine receptor polymorphism (rs1051730) on chromosome 15q25 marking the gene cluster CHRNA3-CHRNB4-CHRNA5, smoking behavior, and tobacco-related cancer and lung and cardiovascular diseases in the general population. Methods Ten thousand three hundred thirty participants from the Copenhagen City Heart Study were genotyped and observed prospectively with up to 18 years of 100% complete follow-up. Smoking behavior was measured at baseline. End points were lung cancer, bladder cancer, chronic obstructive pulmonary disease, ischemic heart disease, and ischemic stroke. Results Multifactorially adjusted and genotype-adjusted subhazard ratios for a cumulative tobacco consumption above 40 pack-years versus 0 pack-years were 32.5 (95% CI, 12.0 to 87.7) for lung cancer, 2.2 (95% CI, 1.1 to 4.5) for bladder cancer, 9.4 (95% CI, 6.9 to 12.7) for chronic obstructive pulmonary disease, 1.5 (95% CI, 1.3 to 1.8) for ischemic heart disease, and 1.1 (95% CI, 0.8 to 1.4) for ischemic stroke. Among smoking noncarriers and homozygotes, daily tobacco consumption was 16 and 18 g/d (P < .001), cumulative tobacco consumption was 28 and 31 pack-years (P = .003), and smoking inhalation was 71.9% and 78.1% (P < .001), respectively. Multifactorially adjusted and smoking behavior–adjusted subhazard ratios for homozygotes versus noncarriers were 1.6 (95% CI, 1.1 to 2.2) for lung cancer, 1.7 (95% CI, 1.0 to 3.0) for bladder cancer, 1.3 (95% CI, 1.1 to 1.6) for chronic obstructive pulmonary disease, 0.9 (95% CI, 0.7 to 1.0) for ischemic heart disease, and 1.1 (95% CI, 0.8 to 1.4) for ischemic stroke. Conclusion Although smoking is associated with major tobacco-related diseases in the general population, the nicotinic acetylcholine receptor polymorphism is associated with additional increased risk of lung cancer, bladder cancer, and chronic obstructive pulmonary disease after adjustment for smoking.
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Yoon, D., M. Ryu, Y. Park, H. Lee, C. Lee, J. Lee, B. Ryoo, H. Chang, T. Kim und Y. Kang. „Phase II study of everolimus in patients with advanced gastric cancer refractory to chemotherapy including fluoropyrimidine and platinum.“ Journal of Clinical Oncology 29, Nr. 4_suppl (01.02.2011): 93. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.93.
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93 Background: To evaluate feasibility with activity and toxicities of everolimus, a novel inhibitor of mammalian target of rapamycin (mTOR), in patients with advanced gastric cancer (AGC) who failed chemotherapy including both fluoropyrimidine and platinum (FP). Methods: Fifty-four patients were enrolled between Jul 2008 and Feb 2010. Everolimus, 10 mg daily, was given until disease progression or unacceptable toxicity. Primary objective was to determine 4-month progression-free survival (PFS) and secondary objectives were to investigate response rate, toxicity and overall survival OS rate. Pre- (n = 28) and on-treatment (n = 19) tumor biopsies were evaluated for phosphorylated (p) mTOR, pS6 kinase1, pS6 and eukaryotic initiation factor 4E binding protein 1 expression. Results: A total of 180 cycles of everolimus were administered with a median of 2 (range, 1-20) cycles in each patient. Two patients (3.7%) achieved confirmed partial response and 19 patients (35.2%) showed stable disease, resulting in a disease control rate of 38.9%. At a median follow-up duration of 8.7 months in surviving patients (range, 3.0–19.4 months), a 4-month PFS rate was 18.4% with a median PFS of 1.7 months (95% CI, 1.5-2.2 months) and a median OS time was 8.3 months (95% CI, 4.5-12.1 months). Peritoneal metastasis (Hazard ratio [HR], 3.97; 95% CI, 1.54-10.23; p = 0.010) and low expression level of pS6Ser240/4 at baseline (HR, 7.64; 95% CI, 2.591-22.51; p = 0.001) were significantly associated with shorter PFS time. Treatment was in general well tolerated. Toxicities of grade 3/4 included anemia (9.4%), thrombocytopenia (9.4%), hepatic dysfunction (11.3%) and pulmonary toxicities (one interstitial pneumonitis and a diffuse alveolar hemorrhage [DAH] case). The DAH and cardiopulmonary dysfunction in another case resulted in treatment-related mortalities. Conclusions: Everolimus monotherapy showed modest activity against AGC refractory to FP. pS6Ser240/4 might be a potential biomarker for the clinical activity of everolimus. The toxicity profile was generally mild. However, careful monitoring for treatment-related pulmonary complication seems to be required. [Table: see text]
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Moradi, Asaad, Mohammad Zamani und Emadoddin Moudi. „A systematic review and meta-analysis on incidence of prostate cancer in Iran“. Health Promotion Perspectives 9, Nr. 2 (25.05.2019): 92–98. http://dx.doi.org/10.15171/hpp.2019.13.
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Background: Prostate cancer is a global health concern. In Iran, its epidemiology is not precisely recognized. We aimed to evaluate incidence of prostate cancer among Iranian populations. Methods: In this systematic review, we searched the databases PubMed, Web of Sciences, Scopus and Google Scholar for English studies and the databases Magiran, Scientific information Database, IranMedex and IranDoc for Persian studies, using related keywords. The cross sectional articles published from inception to 31 December 2018 were included. Meta-analysis was conducted on the collected data with STATA software using random effects model. Results: Out of 763 articles initially obtained, 9 articles were finally included after applying the predefined exclusion criteria. Analysis of 9 studies on the incidence of prostate cancer showed a crude rate of 7.1 per 100000 population (95% confidence interval [CI]: 5.6-8.6). Also, the pooled age-standardized incidence rate was 8.7 per 100000 (95% CI: 6.7-10.4). Studies performed in the period 2004-2012 had significantly a higher pooled estimate of the crude incidence rate (9.2 per 100000 [95% CI: 7.9-10.4]) compared with those conducted in the period 1996-2003 (4.5 per 100000 [95% CI: 2.8-6.2]). This trend was also observed based on the age-standardized incidence rate (11 per 100000 [95% CI: 9.4-12.5] versus 6.3 per 100000[95% CI: 4-8.5]).Conclusion: Despite low rate of prostate cancer occurrence in Iran, it is recommended that preventive measures be taken against this disease by health policymakers. Also, more epidemiological studies are needed to better find out the pattern of prostate cancer among Iranian populations.
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Merianos, Ashley L., Tierney F. Mancuso, Judith S. Gordon, Kelsi J. Wood, Katherine A. Cimperman und E. Melinda Mahabee-Gittens. „Dual- and Polytobacco/Nicotine Product Use Trends in a National Sample of High School Students“. American Journal of Health Promotion 32, Nr. 5 (26.11.2017): 1280–90. http://dx.doi.org/10.1177/0890117117743361.
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Purpose: The study purpose was to examine changes in patterns of ever and current dual- and polyproduct use over time and to examine demographic and modifiable risk factors including tobacco smoke exposure (TSE). Design: A secondary analysis of the 2013 to 2015 National Youth Tobacco Survey data. Setting: Nationwide high schools were selected. Subjects: A total of 31 022 high school students. Measures: Ever and current (past 30 days) tobacco/nicotine product use, home tobacco/nicotine product use, TSE and e-cigarette vapor exposure, and demographic characteristics were measured. Analysis: Multivariable logistic regression and multinomial logistic regression models. Results: Of the students, 9.4% were ever dual users and 18.6% were ever poly users. Rates of ever/current use of e-cigarettes and hookah increased from 2013 to 2015 (all Ps < .001). In 2015, participants were 4.8 times (95% confidence interval [CI], 4.5-5.2) and 4.0 times (95% CI, 3.5-4.4) more likely to report ever/current e-cigarette use and 1.61 times (95% CI, 1.5-1.7) and 1.48 times (95% CI, 1.3-1.7) more likely to report ever/current hookah use. Participants reporting TSE were 15.4 times (95% CI, 11.5-21.0) more likely to report current poly use, and those with e-cigarette exposure were 10.4 times (95% CI, 7.8-13.8) more likely to report current poly use. Conclusion: From 2013 to 2015, rates of ever and current use of e-cigarettes and hookah increased. Tobacco smoke and e-cigarette exposure were associated with higher rates of dual and poly use. Prevention efforts targeting these products are needed.
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Mohammed-Nour, Ahmed, Mohamed Al-Sewailem und Ahmed H. El-Naggar. „The Influence of Alkalization and Temperature on Ammonia Recovery from Cow Manure and the Chemical Properties of the Effluents“. Sustainability 11, Nr. 8 (25.04.2019): 2441. http://dx.doi.org/10.3390/su11082441.
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Manure is a substantial source of ammonia volatilization into the atmosphere before and after soil application. The purpose of the study was to investigate the effects of temperature and alkalization treatments on the release of ammonia and ammonia recovery (AR) from cow manure and to characterize the chemical properties of the resultant effluents. In a closed glass reactor, 100 g of fresh cow manure was mixed with 100 mL of deionized water and the mixture was treated with various volume of KOH to increase the manure pH to 7, 9, and 12. Ammonia was distilled from the mixture at temperatures of 75, 85, 95, and 100 °C for a maximum of 5 h. Ammonia was received as diluted boric and sulfuric acids. Results indicated that the highest ammonia recovery was 86.3% and 90.2%, which were achieved at a pH of 12 and temperatures of 100 and 95 °C, respectively. The recovered ammonia in boric acid was higher than in sulfuric acid, except at a pH of 12 and temperatures of 95 and 100 °C. The effluents, after ammonia was removed, showed that the variation in pH ranged between 6.30 and 9.38. The electrical conductivity ranged between 4.5 and 9. (dS m−1) and total potassium ranged between 9.4 and 57.2 mg kg−1.
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Lavery, Lawrence A., David C. Lavery, Nathan A. Hunt, Javier La Fontaine und Ryan D. Lavery. „Does the Start of Dialysis Initiate a Period of Increased Risk of Ulceration or Amputation?“ Journal of the American Podiatric Medical Association 108, Nr. 1 (01.01.2018): 1–5. http://dx.doi.org/10.7547/16-056.
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Background: Dialysis therapy is associated with an increased incidence of lower-extremity wounds and amputations. We compared the incidence of foot ulcers and amputations before and after the start of dialysis. Methods: We evaluated 150 consecutive diabetic patients receiving dialysis and compared the incidence of foot complications 30 months before and after initiation of hemodialysis. We used claims data for diabetes, ulceration, and dialysis and abstracted medical records to verify diagnoses and dates of ulcers and amputations. We compared initial and cumulative ulcer/amputation incidence to account for multiple events in the same person over time. We used the same formula to determine the incidence rate difference and 95% confidence intervals (CIs) to compare new ulcers and amputations during the study. Results: There was no significant difference in the incidence of first foot ulcers before (91.7 per 1,000 patient-years; 95% CI, 73.7–112.3 per 1,000 patient-years) and after (82.7; 95% CI, 65.7–102.3) the start of hemodialysis. The incidence of cumulative ulcers was significantly higher before (304.0 per 1,000 patient-years; 95% CI, 270.8–340.2) compared with after (210.7 per 1,000 patient-years; 95% CI, 183.0–240.9) dialysis. There was no difference in the incidence of first amputation before (29.3 per 1,000 patient-years; 95% CI, 1 9.4–41.7 per 1,000 patient-years) and after (37.3 per 1,000 patient-years; 95% CI, 19.4–41.7 per 1,000 patient-years) dialysis or in the cumulative incidence of amputations before (61.3 per 1,000 patient-years; 95% CI, 46.7–8.4 per 1,000 patient-years) and after (58.7 per 1,000 patient-years; 95% CI, 44.5–75.5 per 1,000 patient-years) dialysis. Conclusions: There was no increase in the incidence of ulcers or amputations after beginning hemodialysis.
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Sherry, J. „Innkeeper's liability management by Gary M. Bakker and John R. Abele, Lawyers and Judges Publishing Company, 917 North Swan Road, Suite 300, Tucson, Arizona 85711-1213, © 1995, 448 pp., hard cover, $71.50“. Cornell Hotel and Restaurant Administration Quarterly 36, Nr. 5 (Oktober 1995): 17. http://dx.doi.org/10.1016/0010-8804(95)80018-2.
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Guo, Jing, David I. Givens und Berit Lilienthal Heitmann. „Association between dairy consumption and cardiovascular disease events, bone fracture and all-cause mortality“. PLOS ONE 17, Nr. 9 (09.09.2022): e0271168. http://dx.doi.org/10.1371/journal.pone.0271168.
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Dairy products are important constituents of a healthy and balanced diet, but their association with health outcomes remains to be established. We investigated the association of total dairy, total fermented dairy, and different dairy subtypes (including total/high-fat/low-fat milk, yogurt, cheese, butter, and cream) and the risk of cardiovascular disease (CVD), coronary heart disease (CHD), bone fracture and all-cause mortality among 1746 Danish healthy men and women (30–60 years, 52%female). Hazard ratios (HRs) and 95% CIs were estimated using the multivariable Cox proportional hazard models. During a mean follow-up of 30 years, incident cases of CVD (n = 904), CHD (n = 332), fracture (n = 447) and all-cause mortality (n = 680) were reported. High intake of total fermented dairy was associated with lower fracture risk (HR 0.67, 95% CI: 0.51–0.90, P = 0.02) than observed in the lowest tertile of the fermented dairy group. Furthermore, high intake of low-fat milk was associated with lower risks of CVD (HR 0.84, 95% CI: 0.68–1.03, P = 0.03), CHD (HR 0.82, 95% CI: 0.59–1.16, P = 0.04), and all-cause mortality (HR 0.77, 95% CI: 0.61–0.97, P = 0.004) compared with the lowest tertile of low-fat milk group. No associations were found with other dairy subtypes. The findings from this prospective cohort study suggest an inverse association between total fermented dairy and fracture risk, and also inverse associations were found between low-fat milk consumption and risk of CVD, CHD and all-cause mortality.
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Meloni, Marco, Valentina Izzo, Laura Giurato, Enrico Brocco, Roberto Gandini und Luigi Uccioli. „Limb Salvage in Diabetic Patients With Ischemic Heel Ulcers“. International Journal of Lower Extremity Wounds 19, Nr. 3 (20.11.2019): 275–81. http://dx.doi.org/10.1177/1534734619884438.
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The purpose of this study is to investigate the outcomes of diabetic individuals with ischemic heel ulcers. The study group was composed of a consecutive sample of persons with diabetic ischemic foot ulcers managed by a preset multidisciplinary limb salvage protocol, including revascularization through endovascular technique. The outcome measures were healing, major amputation (above the ankle), and death at 1-year of follow-up. The outcomes between patients with heel ulcers (HUs) and without (NHUs) were compared. A total of 254 patients were recruited. There were 50/254 (19.7%) HUs and 204/254 (79.3%) NHUs. Overall, 190/254 (74.8%) patients healed. The rate of healing for HUs and NHUs was 30/50 (60%) and 160/204 (78.4%); P = .03, respectively. Major amputation occurred in 24/254 (9.4%) patients. The rates of major amputation for HUs and NHUs were 10/50 (20%) and 14/204 (6.9%; P = .002), respectively; 40/254 (15.7%) patients died, unhealed. The rates of mortality for HUs and NHUs were 10/50 (20%) and 30/204 (14.7%; P = .07), respectively. In HUs patients, absence of infection [95% CI = 3.1 (1.6-5.5); P = .002] and superficial ulcers [95% CI = 4.4 (2.2-9.3); P = .0001] were independent predictors of healing, whereas revascularization failure [95% CI = 8.1 (1.5.0-19.4); P = .0001], involvement of the plantar arch [95% CI = 6.3 (2.0-15.4); P = .0001], and dialysis [95% CI = 2.2 (1.3-4.5); P = .006] were independent predictors of major amputation. A multidisciplinary approach achieves good rate of limb salvage in people with diabetic ischemic heel ulcers.
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Ambarsari, Cahyani Gita, Partini Pudjiastuti Trihono, Agustina Kadaristiana, Taralan Tambunan, Lily Mushahar, Henny Adriani Puspitasari, Eka Laksmi Hidayati und Sudung Oloan Pardede. „Five-year experience of continuous ambulatory peritoneal dialysis in children: a single center experience in a developing country“. Medical Journal of Indonesia 28, Nr. 4 (13.12.2019): 329–37. http://dx.doi.org/10.13181/mji.v28i4.3807.
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BACKGROUND The pediatric peritoneal dialysis (PD) program in Cipto Mangunkusumo Hospital, Indonesia was started in 2014. However, there has been no published data on the patients’ outcome. This study was aimed to report the characteristics and outcomes of a continuous ambulatory peritoneal dialysis (CAPD) program for children.
METHODS This retrospective study was conducted in Cipto Mangunkusumo Hospital as a national referral hospital. Data were collected from medical records of patients aged ≤18 years with end-stage renal disease who underwent CAPD in 2014–2019. The baseline characteristics, PD-related infection rate, as well as patient and technique survivals were analyzed.
RESULTS Out of 60 patients who underwent CAPD, 36 (60%) were boys on the age range of 4 months–18 years. The mean follow-up duration was 12 (95% confidence interval [CI] = 9.4–15.3) months. The number of PD related infections increased along with the growing number of patients on CAPD. The peritonitis rate was 0.42 episodes per year at risk, and the most common etiology was alpha-hemolytic Streptococcus (5/24, [20.8%]). The 1- and 3-year technique survival rates were 60.3% (95% CI = 44.5–72.9) and 43.9% (95% CI = 23.2–62.9). The 1- and 3-year patient survival rates were 69.6% (95% CI = 52.5–81.5) and 58% (95% CI = 31.2–77.5).
CONCLUSIONS In this unit, CAPD could be performed in children as young as 4 months of age. The peritonitis rate was relatively low which was likely caused by skin-derived microorganisms. Both technique survival and patient survival were also relatively low.