bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of modified docetaxel, oxaliplatin, capecitabine followed by capecitabine as maintenance chemotherapy as first-line therapy for patients with metastatic gastric or gastroesophageal cancer
Authors: Petrioli Roberto , Francini Edoardo , Cherri Sara , Marrelli Daniele , Rovello Franco , Fiaschi Anna Ida , Miano Salvatora Tindara , Savelli Vinno , Calomino Natale , Farsi Marco , Vernillo Remo , Francini Guido
Published: December 2019

The aim of this study was to evaluate the efficacy and safety of modified docetaxel, oxaliplatin, capecitabine (DOC) combination chemotherapy, followed by maintenance capecitabine as first-line therapy for patients with metastatic gastric or gastroesophageal junction (GEJ) cancer. Treatment consisted of docetaxel 35 mg/m2 (days 1–8), l-OHP 85 mg/m2 (day 1), and capecitabine 750 mg/m2 twice daily (days 1–14), every 3 weeks. After six cycles of DOC, patients who did not progress received maintenance treatment with three-weekly capecitabine 1000 mg/m2 twice daily (days 1–14), until disease progression or unacceptable toxicity. Six-month disease control rate (DCR) was the primary endpoint and overall survival (OS), progression-free survival (PFS) and safety were the secondary endpoints. The Kaplan–Meier method was applied to estimate OS and PFS. Between July 2014 and September 2017, 37 patients with metastatic gastric or GEJ cancer were enrolled at our institution. Upon completion of the DOC regimen, 35 patients (94.5%) received capecitabine as maintenance chemotherapy for a median of 7 cycles (range, 3–14 cycles). The six-month DCR was 83.7% [95% confidence interval (CI), 71.8–95.6%], median PFS was 8.2 months (95% CI, 6.3–9.8 months), and median OS was 14.4 months (95% CI, 11.7–18.6 months). During DOC chemotherapy, the most common grade 3–4 adverse events were neutropenia (29.7%), anemia (10.8%), and diarrhea (10.8%). During maintenance treatment, toxicity was sporadic and mainly of grade 1–2. Modified DOC followed by capecitabine as maintenance chemotherapy seems to be an active and well tolerated first-line treatment strategy for patients with metastatic gastric and GEJ cancer.
Symptom relief and palliative care in gynecologic oncology
Authors: Roy Mohana , Ramchandran Kavitha
Published: December 2019

Purpose of review

Patients with gynecologic malignancies experience varied and often difficult-to-manage symptoms through their disease course, along with decisions surrounding preferences for advance care planning. This review focuses on evidence-based symptom management for these patients and offers a framework for conversations regarding goals of therapy.

Recent findings

There is increasing literature on palliative care specifically in gynecologic oncology, including barriers and possible solutions for early palliative care use, along with updated guidelines on postoperative pain management and tools for communication.

Integration of early palliative care and focus on symptom management is an important and multidisciplinary approach to help patients with gynecologic malignancies.
Aldosterone-potassium ratio predicts primary aldosteronism subtype
Authors: Puar Troy H. , Loh Wann J. , Lim Dawn ST , Loh Lih M. , Zhang Meifen , Foo Roger S. , Lee Lynette , Swee Du S. , Khoo Joan , Tay Donovan , Kam Jia W. , Dekkers Tanja , Velema Marieke , Deinum Jaap , Kek Peng C.
Published: December 2019

Objective:

Prediction models have been developed to predict either unilateral or bilateral primary aldosteronism, and these have not been validated externally. We aimed to develop a simplified score to predict both subtypes and validate this externally.

Methods:

Our development cohort was taken from 165 patients who underwent adrenal vein sampling (AVS) in two Asian tertiary centres. Unilateral disease was determined using both AVS and postoperative outcome. Multivariable analysis was used to construct prediction models. We validated our tool in a European cohort of 97 patients enrolled in the SPARTACUS trial who underwent AVS. Previously published prediction models were also tested in our cohorts.

Results:

Backward stepwise logistic regression analysis yielded a final tool using baseline aldosterone-to-lowest-potassium ratio (APR, ng/dl/mmol/l), with an area under receiver-operating characteristic curve of 0.80 (95% CI 0.70–0.89). In the Asian development cohort, probability of bilateral disease was 90.0% (with APR <5) and probability of unilateral disease was 91.4% (with APR >15). Similar results were seen in the European validation cohort. Combining both cohorts, probability of bilateral disease was 76.7% (with APR <5), and probability for unilateral was 91.7% (with APR >15). Other models had similar predictive ability but required more variables, and were less sensitive for identifying bilateral PA.

Conclusion:

The novel aldosterone-to-lowest-potassium ratio is a convenient score to guide clinicians and patients of various ethnicities on the probability of primary aldosteronism subtype. Using APR to identify patients more likely to benefit from AVS may be a cost-effective strategy to manage this common condition.
Analysis of Risk Factors in Occupational Accidents in Brazil
Authors: Monteiro Ferreira Marcelo José , Silveira Correa Francisco Gustavo , Lacerda Eliana Mattos , Hajat Shakoor , de Araújo Larissa Fortunato
Published: December 2019

Objective:

To investigate the association of occupational risks factors, including specific work characteristics with the occurrence of accidents at workplace and on the way to work in Brazil.

Methods:

We used a cross-sectional study design with comparison groups, to inquire data from 47,629 participants of the Brazilian National Health Survey. Logistic regression analysis was performed for distinct multivariate models.

Results:

Exposure to intense noise, biological materials, work experience of 40 years or more, and intense physical exertion were significantly associated with accidents at work. Regarding to accidents on the way to work, exposure to intense noise and performing work activities that require intense physical exertion remained associated.

Conclusion:

This study contributes to highlight the effects of multiple work-related risk factors on the occurrence of occupational accidents at the workplace and on the way to work in Brazil.
The Impact of Oral Health on Work Performance of Japanese Workers
Authors: Zaitsu Takashi , Saito Tomoya , Oshiro Akiko , Fujiwara Takeo , Kawaguchi Yoko
Published: December 2019

Objective:

The aim of this study was to investigate the association between oral health and work performance measured as absenteeism and presenteeism.

Methods:

Study participants were employees (mean age: 42.7 ± 11.4 years) of 11 companies in Japan. Oral examination and self-administered questionnaires provided information on industrial category, work schedule, work performance (absenteeism and presenteeism), and smoking status.

Results:

The proportion of absenteeism (2.7%) or presenteeism (6.8%) of workers caused by oral health problems was low. Logistic regression analysis showed that the risk of absenteeism due to oral health problems was not significantly related to occupation or oral health status. However, the risk of presenteeism caused by oral health problems was 2.01 (95% confidence interval, 1.03 to 3.92) times higher among participants with periodontitis.

Conclusions:

Periodontal disease is associated with presenteeism of workers. It is considered that the periodontal disease countermeasure in the workplace should be provided.
Toward Easy and Rapid Bronchial Occlusion With an Endobronchial Watanabe Spigot
Authors: Mizumori Yasuyuki , Nakahara Yasuharu , Hirata Nobuya , Hiraoka Ryota , Kominami Ryota , Hirano Katsuya , Hanaoka Kenji , Katsuda Rinko , Miyake Kohei , Kawamura Tetsuji
Published: December 2019

Background:

Bronchial occlusion using an endobronchial Watanabe spigot (EWS) is reportedly effective for intractable bronchopleural fistula. Here, we describe a rapid and easy method for bronchial occlusion using a guide sheath (GS) and curette.

Methods:

Thirty consecutive patients who underwent bronchial occlusion under mild sedation between October 2014 and February 2018 were enrolled. The devices used were a flexible bronchoscope (BF-1T260 or BF-1TQ290), GS (SG-201C; with 30 mm of the proximal end cutaway), and a CC-4CR-1 curette (all supplied by Olympus Ltd). The curette was inserted into the GS with the tip of the curette exposed outside the GS. The curette and GS were inserted into the bronchoscope. The EWS attached to the curette tip was inserted into the target bronchus and left in position by pulling the curette back through the GS while pushing the EWS with the GS under the bronchoscopic view. The success rate and procedure time were recorded.

Results:

Bronchial occlusion with an EWS was performed on 143 target bronchi (2 to 9 bronchi/patient). The bronchial occlusion success rate was 98.6%. The median procedure time for bronchial occlusion per EWS on video recordings of the 10 most recent procedures was 110 (range, 40 to 521) seconds. The target bronchial occlusion success rate was 100%. This method enabled easy insertion of the EWS, even in the sharply branching upper lobe bronchus. No complications were observed.

Conclusion:

Bronchial occlusion using a GS and curette is a rapid and easy technique even in a sharply branching target bronchus.
Preoperative biometric measurements with anterior segment optical coherence tomography and prediction of postoperative intraocular lens position
Authors: Yoo Young-Sik , Whang Woong-Joo , Kim Hyun-Seung , Joo Choun-Ki , Yoon Geunyoung
Published: December 2019

The purpose of this study is to evaluate the biometric parameters of crystalline lens components and to find effective factors for predicting postoperative intraocular lens (IOL) position. This retrospective study included 97 eyes from 97 patients with a mean age of 63.00 ± 12.38 (SD) years. The biometric measurements were performed by means of a 3-dimensional optical coherence tomography (3D-OCT) device. Specifically, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), lens meridian parameter (LMP), white-to-white diameters (WTW), anterior segment length (ASL), the anterior part of lens (aLT), and the posterior part of lens (pLT) were measured. Additionally, axial length (AL) and corneal radius (CR) were measured by the partial coherence interferometry. Ninety-seven eyes were divided into thin lens group (LT < 4.5 mm) and thick lens group (LT ≥ 4.5 mm). The differences between the above two groups were also analyzed. Postoperative IOL position was measured by 3D-OCT at 3 months postoperatively and regression formulas for predicting postoperative IOL position were developed by various combinations of preoperative factors. As lens thickened, ACD and AD became shallow (all P < .001). AD, ACD, ASL, aLT, and pLT showed statistically significant differences between two subgroups classified on the basis of LT (all P < .001). Meanwhile, the value obtained by subtracting aLT from pLT did not show any association with the other biometric measurements. The combination of ACD, aLT, pLT, AL, CR, and WTW showed the highest correlation with postoperative IOL position (R
2 = 0.536, P < .001). In conclusion, pLT–aLT was an independent factor not affected by any other variables and did not show significant difference between thin lens group and thick lens group. The subdivision of the lens structure using 3D-OCT helps to predict postoperative IOL position.
McCune Albright syndrome is a genetic predisposition to intraductal papillary and mucinous neoplasms of the pancreas associated pancreatic cancer in relation with GNAS somatic mutation – a case report
Authors: Gaujoux Sébastien , Pasmant Eric , Silve Caroline , Mehsen-Cetre Nadia , Coriat Romain , Rouquette Alexandre , Douset Bertrand , Prat Frédéric , Leroy Karen
Published: December 2019

Rationale:

Intraductal papillary and mucinous neoplasms of the pancreas (IPMN) are preneoplastic lesions diagnosed with an increasing incidence. Recently, several groups have described, in up to 70% of IPMN, activating mutations of the G-protein alpha stimulatory sub-unit (Gsα subunit) gene (GNAS). GNAS-activating somatic, post-zygotic, mutations are also associated with McCune-Albright syndrome (MCAS) characterized by fibrous dysplasia, precocious puberty, and café-au-lait spots.

Patient concerns:

We herein report a patient with McCune Albright Syndrome that presented with malignant IPMN and underwent pancreatic resection.

Diagnoses and interventions:

Leucocyte and duodenum juice DNA analysis, endoscopically collected from secretin-stimulated pancreatic juice revealed the same (GNAS) activating mutation also found in the invasive pancreatic colloid adenocarcinoma arising from intestinal subtype IPMN.

Outcomes:

Thirty months after surgery, the patient was alive with recurrence (bone only metastasis).

Lessons:

In this observation, we show that MCAS should be view as a new genetic predisposition to IPMN associated pancreatic cancer, and consequently a targeted screening in this high-risk population might be proposed.
Two case reports
Authors: Niu Zihan , Meng Hua , Zhang Xiaoyan , Ouyang Yunshu , Zhang Yixiu , Wu Xining
Published: December 2019

Rationale:

The significant ultrasonic characteristics of amniotic band syndrome (ABS) are the malformations of fetal affected parts and the band—like echoes in amniotic cavity. This article first suggests that the fetal hand adhered to umbilical cord with restricted movement provides some values in the diagnosis of ABS in early gestational weeks especially when the fetal malformation is not obvious and amniotic band is thin and fine.

Patient concerns:

Two pregnant women had no discomfort and underwent routine ultrasound examination at 11 to 14 gestational weeks.

Diagnosis:

Only the fetal hand adhered to umbilical cord with restricted movement was detected during the first ultrasound examination at 11∼14 gestational weeks, and the floating band-like echos were detected in the amniotic cavity with follow-up examinations 2 to 3 weeks later. Both of the 2 fetus were diagnosed as ABS by ultrasound

Interventions:

The two pregnant women underwent the prenatal counseling and were recommended closely follow-up and further examination.

Outcomes:

Two fetuses died in utero between 17 and 19 weeks. After induction of labor, it was found that the hands and umbilical cord of the fetuses were wrapped by amniotic bands, which was proved pathologically as ABS.

Lessons:

The adhesion of the fetal hand and umbilical cord is an important ultrasonic sign suggesting ABS with poor prognosis in early pregnancy. We hope that this study can provide some guidance for the early diagnosis of ABS during 11 to 14 week's ultrasound examination.
Concomitant lung adenocarcinoma and pulmonary cryptococcosis confirmed by pathologic examinations
Authors: Huang Jinbao , Lan Changqing , Li Hongyan , Chen Shuxing , Lin Qinghua , Weng Heng
Published: December 2019

To describe the characteristics of concomitant lung cancer and pulmonary cryptococcosis (PC) cases.

A total of 8 patients with lung cancer and coexisting PC, who were admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31st December 2015 and whose diagnoses were confirmed by pathological examinations, were studied.

One patient had a history of diabetes mellitus and 1 had a history of treated with surgery. The lesions in 7 cases manifested as nodular shadows; only 1 case showed the lesion of the 2 diseases mergedmixed together, and it manifested as a large flake-like infiltrated shadow in the same lobe. The histological type in all of the patients was lung adenocarcinoma. Lung cancer stage was advanced (III–IV) in 25.0% of the cases. The 5 patients who received surgery and drug treatment are presently healthy following resection. Recurrence and metastasis of lung cancer following surgery occurred in 2 patients in whom the tumor was controlled again after anti-tumor treatment. One patient with advanced lung cancer and PC was treated with antifungal therapy in combination with antineoplastic chemotherapy, but she failed to improve and died 10 months after symptom onset during the follow-up period.

PC coexisting with pulmonary carcinoma is rare. PC can manifest as pulmonary nodules and mimic malignant lesions, so it must be considered during a differential diagnosis of pulmonary nodules, especially in immunosuppressed patients.
Efficacy and safety of Cortex Eucommiae (Eucommia ulmoides Oliver) extract in subjects with mild osteoarthritis
Authors: Ahn Hyeon Yeong , Cho Jae-Heung , Nam Dongwoo , Kim Eun-Jung , Ha In-Hyuk
Published: December 2019

Background

Osteoarthritis (OA) is a major degenerative disease that affects the elderly. The global prevalence of OA is increasing annually. However, current treatments are unable to halt the progress of OA. At present, pharmacological treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors control the pain; however, there may be side effects to these medications. We hypothesized that Cortex Eucommiae (CE; Eucommia ulmoides Oliver) extract, which is used as a dietary supplement, may slow down or prevent OA.

Methods

This is a protocol for a 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of CE extract in subjects with mild OA. One-hundred subjects with mild OA will be recruited and randomly divided in a 1:1 ratio into 2 groups. One group will receive CE extract for 12 weeks and the other group will receive placebo for 12 weeks. Outcomes will be evaluated by using the visual analog scale (VAS), Korean-Western Ontario and McMaster Universities index (K-WOMAC), Korean-Short Form health survey-36 score (KSF-36), and laboratory test results.

Discussion

This clinical trial is expected to provide evidence of the efficacy and safety of CE extract as a treatment for mild OA.

Trial registration

Clinical Trials.gov NCT03744611, registered on November 12, 2018, at https://clinicaltrials.gov/ct2/show/NCT03744611
Gamma-glutamyl transpeptidase-to-platelet ratio and the fibrosis-4 index in predicting hepatitis B virus-related hepatocellular carcinoma development in elderly chronic hepatitis B patients in China
Authors: Zhu Yun-Feng , Tan Yi-Fei , Xu Xi , Zheng Jin-Li , Zhang Bo-Han , Tang Huai-Rong , Yang Jia-Yin
Published: December 2019

Gamma-glutamyl transpeptidase-to-platelet ratio (GPR) and fibrosis-4 (FIB-4) index have been reported to be useful predictors in predicting hepatocellular carcinoma (HCC) development in chronic hepatitis B (CHB) patients. However, their predictive performances on HCC development have not been validated in elderly patients. Thus, the aim of this study was to evaluate the predictive values of the GPR and FIB-4 index on HCC in elderly CHB patients with in China.

Between January 2007 and December 2016, 1011 CHB patients older than 60 years were enrolled in the study, and their data were retrospectively analyzed. Receiver-operating characteristic (ROC) curve analysis was used to determine the optimal cutoff points of GPR and the FIB-4 index. Cumulative HCC incidence rates were calculated by the Kaplan–Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to detect risk factors for HCC development. The prediction performances of GPR and FIB-4 index were compared based on time-dependent ROC analyses.

After a median follow-up of 6.8 (interquartile range 3.9–8.4) years, 39 (3.9%) patients developed HCC. The ROC analysis of GPR and the FIB-4 index at the 5-year time point revealed that the optimal cutoff point was 0.23 for GPR and 4.15 for the FIB-4 index. When stratified by low and high GPR values and FIB-4 indices, the patients’ subgroups showed significantly different cumulative incidences of HCC. The multivariate analysis revealed that high GPR (hazard ratio [HR] 4.224; 95% confidence interval [CI] 1.891–9.434, P < .001) was an independent risk factor for HCC development, whereas a high FIB-4 index was not (HR 0.470; 95% CI 0.212–1.043; P = .063). In the time-dependent ROC analysis, GPR showed higher area under curve (AUC) values than the FIB-4 index did at all time points and reached statistical significance at the 5-, 7-, and 10-year time points (GPR vs FIB-4 index, AUC 0.725 vs 0.549 at 5 years, P = .005; GPR vs FIB-4 index, AUC 0.733 vs 0.578 at 7 years, P = .001; GPR vs FIB-4 index, AUC 0.837 vs 0.475 at 10 years, P < .001).

In conclusion, our study suggests GPR is superior to the FIB-4 index in predicting HCC development in elderly CHB patients in China.
Thyroid imaging reporting and data system combined with Bethesda classification in qualitative thyroid nodule diagnosis
Authors: Tan Huiwen , Li Zhihui , Li Nong , Qian Jianrong , Fan Fengchun , Zhong Huiling , Feng Jinquan , Xu Huajun , Li Zhongxing
Published: December 2019

Objective:

We aimed to investigate the value of the combined use of high-resolution ultrasound thyroid imaging reporting and data system (TI-RADS) classification and thyroid fine needle aspiration cytology (Bethesda classification) for the qualitative diagnosis of benign and malignant thyroid nodules.

Methods:

We enrolled 295 patients with 327 thyroid nodules who were scheduled to undergo thyroid nodule surgery. Before surgery, all the patients underwent ultrasound and scoring with the TI-RADS classification, along with thyroid fine needle biopsy cytology under ultrasound guidance (US-FNAC) and scoring with the Bethesda classification. After surgery, the TI-RADS and Bethesda classification scores, separately and in combination, were compared with the postoperative pathological results in terms of the differential diagnosis of thyroid nodules.

Results:

TI-RADS classification score 4 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 92.7%, 70.7%, and 87.1%, respectively, whereas the Kappa and receiver-operating characteristics (ROC) values were 0.651 and 0.817, respectively. Moreover, Bethesda classification score 3 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 90.0%, 94.3%, and 91.1%, respectively, whereas the Kappa and ROC values were 0.78 and 0.914, respectively. With regard to the combined diagnostic method, a score of 7 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 97.3%, 92.0%, and 95.9%, respectively, whereas the Kappa and ROC values were 0.893 and 0.946, respectively.

Conclusion:

The combination of high-resolution ultrasonography TI-RADS classification and US-FNAC (Bethesda classification) can improve the accuracy of malignant thyroid nodules diagnosis.
Effect of herbal tea on glycemic control in patients with type 2 diabetes
Authors: Zhang Boxun , Yue Rensong , Huang Xiaoying , Wang Ying , Jiang Yayi , Chin Jiawei
Published: December 2019

Background:

Type 2 diabetes (T2D) is a significant health concern worldwide, and good glycemic control is the basis of avoiding disease progression. Herbal tea, as a convenient and effective medication method, has gained popularity among many diabetic patients. However, there are no systematic reviews or meta-analyses to evaluate the clinical efficacy of herbal tea on T2D.

Methods:

Four English electronic databases and 4 Chinese electronic databases were searched for randomized controlled trials (RCTs) meeting inclusion criteria; Clinical trials were searched to explore the relevant unpublished data. Fasting blood glucose and glycated hemoglobin will be measured as primary outcomes. Secondary outcomes include 2-hour postprandial blood glucose, fasting insulin, and homeostasis model assessment-insulin resistance. The heterogeneity of data will be investigated by Chi-square and I
2 test; subgroup analysis and sensitivity analysis will be conducted to explore the sources of heterogeneity; funnel plot will be used to evaluate publication bias; finally, we will use grading of recommendations assessment, development, and evaluate system method to evaluate the quality of evidence. Merging analysis of data will be performed using Rev Man 5.3 software.

Results:

The results will be published in a peer-reviewed journal.

Conclusions:

The systematic review will confirm whether herbal tea consumption is benefit to the glycemic control in patients with T2D.

PROSPERO registration number:

CRD42019129863.
Prognostic significance and molecular mechanisms of adenosine triphosphate-binding cassette subfamily C members in gastric cancer
Authors: Mao Xianshuang , He Zhenhua , Zhou Fengsheng , Huang Yongchu , Zhu Guangzhi
Published: December 2019

Gastric cancer (GC) is one of the major leading causes of tumor-related deaths worldwide. Adenosine triphosphate-binding cassette subfamily C (ABCC) consists of 13 members, ABCC1 to 13, which were examined for their associations with GC.

The online Kaplan–Meier Plotter database was used to determine the prognostic significance of ABCC subfamily members in GC. Stratified analyses were performed using gender, disease stage, degree of tumor differentiation, expression of human epidermal growth factor receptor 2 (HER2), and Lauren classification. Molecular mechanisms were examined using the database for annotation, visualization, and integrated discovery database.

ABCC1, ABCC3, ABCC7, ABCC8, ABCC9, and ABCC10 expression showed prognostic significance in the whole population and in male and female subpopulations (all P ≤ .05). Furthermore, high expression of most ABCC family members always suggested a poor prognosis, except for ABCC7 (P > .05). Stratified analyses revealed that ABCC1, ABCC3, ABCC7, ABCC8, ABCC9, and ABCC10 expression showed prognostic significance for the whole population, as well as male and female populations. ABCC2 and ABCC9 were significantly correlated with all disease stages, while ABCC2 and ABCC6 were significantly correlated with all Lauren classifications. Expression of ABCC1, ABCC3, ABCC5, ABCC7, ABCC8, ABCC9, and ABCC10 was significantly correlated with either negative or positive of HER2 status (all P ≤ .05). Enrichment analysis indicated that these genes were involved in ATPase activity, transmembrane transport, or were ABC transporters (all P ≤ .05).

ABCC1, ABCC3, ABCC7, ABCC8, ABCC9, and ABCC10 may be potential prognosis biomarkers for GC, acting as ABC transporters and via ATPase activity.
Intracavitary electrocardiogram guidance for placement of peripherally inserted central catheters in premature infants
Authors: Yang Lijuan , Bing Xu , Song Luo , Na Chen , Minghong Dai , Annuo Liu
Published: December 2019

This study evaluated the accuracy of intracavitary electrocardiogram (IC-ECG) guidance for placement of peripherally inserted central catheters (PICCs) in premature infants, relative to chest X-ray.

Premature infants (n = 173) underwent placement of a PICC monitored by ECG, and a stable heart rhythm was shown. Changes in the P wave of the ECG reflected the position of the catheter tip, and a characterized P wave indicated the correct position. The P wave results were compared with a chest X-ray.

P wave changes were observed in 157 (90.75%) of the premature infants on the ECG. Among them, the catheter tips of 148 (85.55%) and nine (5.20%) patients were in the correct and non-correct position, respectively, which was confirmed by chest X-ray. No characteristic P wave changes were observed in 16 (9.32%) patients on ECG, in which the catheter tips of eight (4.62%) patients each were in the correct and non-correct position, according to the chest X-ray. The accuracy of IC-ECG guidance for placement of the PICC was 90.17%. The PICC tip location results of the IC-ECGs were statistically similar to that of the chest X-rays.

IC-ECG guidance is accurate for placement of PICC in premature infants, and provides an economical assessment without radiation.
Pooled analysis of prognostic value and clinical significance of Rab1A expression in human solid tumors
Authors: Shao Xinyu , Cheng Zhengwu , Xu Menglin , Tan Zhuqing , Gao Ling , Wang Junfeng , Zhou Chunli
Published: December 2019

Background:

This study aims to assess the relationship between Rab1A expression and clinicopathological parameters and prognosis of patients with human solid cancer by summarizing the studies included.

Methods:

PubMed, EMBASE, The Cochrane Library, and other sources were searched for relative studies. The risk ratios (RRs) and confidence interval (CI) were used to assess association between Rab1A expression and clinical parameters and prognosis in solid cancer patients.

Results:

Eight studies were included in the final analysis with 800 patients. The results revealed that expression of Rab1A was significantly related with differentiation (RR = 0.883, 95%CI = 0.782–0.997, P = .044), lymph node metastasis (RR = 0.835, 95%CI = 0.753–0.926, P = .001), tumor-lymph node-metastasis (TNM) stage (RR = 1.190, 95%CI = 1.071–1.322, P < .001) and tumor size (RR = 0.818, 95%CI = 0.730–0.915, P < .001). What is more, no significant difference was seen in 1-year survival between high and low expression of Rab1A in multiple malignancies (RR = 0.855, 95%CI = 0.697–1.050, P = .136). However, increased Rab1A revealed poorer prognosis with 2-year survival (RR = 0.760, 95%CI = 0.701–0.824, P < .001), 3-year survival (RR = 0.669, 95%CI = 0.604–0.742, P < .001), 4-year survival (RR = 0.622, 95%CI = 0.554–0.698, P < .001) and 5-year survival (RR = 0.525, 95%CI = 0.458–0.698, P < .001). Expression of Rab1A was increased obviously in solid cancer tissues compared with the adjacent normal tissue (RR = 4.78, 95%CI 4.05–5.63, P = .015).

Conclusion:

This study revealed Rab1A expression links closely with tumor size, differentiation, lymph node metastasis, TNM stage and poor prognosis of human solid cancer patients. It may act as a biomarker of prognosis and a novel therapeutic target in solid cancer.
Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly patients with colorectal cancer
Authors: Chiou Wen-Yen , Hung Shih-Kai , Lin Hon-Yi , Chen Liang-Cheng , Hsu Feng-Chun , Tsai Shiang-Jiun , Yu Ben-Hui , Lee Moon-Sing , Li Chung-Yi
Published: December 2019

The commonly used vaccine for adults with a high risk of pneumonia is 23-valent pneumococcal polysaccharide vaccine (PPSV23). However, its effectiveness in patients with colorectal cancer has not been investigated. This study aimed to investigate the effectiveness of PPSV23 in reducing the risk of pneumonia among elderly patients with colorectal cancer.

A total of 120,605 newly diagnosed patients with colorectal cancer were identified from the Taiwan National Health Insurance Research Database between 1996 and 2010. Of these patients, 18,468 were 75 years or older in 2007 to 2010, and 3515 received PPSV23. People aged 75 years or older have been considered eligible for receiving PPSV23 vaccination in Taiwan since 2007. The specific “vaccination period” of October 2008 to December 2008 was used to minimize the potential immortal time bias. Therefore, 893 patients who received PPSV23 outside this vaccination period or died before 2009 and 2960 unvaccinated patients who died before 2009 were excluded. After the propensity score was matched with a 1:3 ratio, 2622 vaccinated patients and 7866 unvaccinated patients were recruited. A multivariate log-linear Poisson regression model was performed and adjusted for potential confounders, including influenza vaccination, vaccination period, cancer treatment modalities, comorbidities, and sociodemographic variables.

After 2 years of follow-up, the incidence rate of the pneumonia hospitalization of the vaccinated patients was significantly lower than that of the unvaccinated patients at 85.53 per 1000 person-years (PYs) of the former and 92.38 per 1000 PYs of the latter. The proportions of patients who had 2, 3, and >3 pneumonia hospitalizations per year were consistently lower in the vaccinated group than in the unvaccinated group (1.9% vs 2.0%, 0.5% vs 0.9%, and 0.7% vs 1.1%, respectively). After adjustment for covariates was made, PPSV23 vaccine was significantly associated with a reduced risk of pneumonia hospitalization, with an adjusted incidence rate ratio of 0.88 (P = .040). The overall pneumonia-free survival rate was also significantly higher in the vaccinated patients than in the unvaccinated patients (P = .001).

PPSV23 vaccination was associated with a significantly reduced rate of pneumonia hospitalization in elderly patients with colorectal cancer.
A case report of primary prostate intravascular large B cell lymphoma presenting as prostatic hyperplasia
Authors: Zhu Fang , Pan Huaxiong , Xiao Yin , Li Qiuhui , Liu Tao , Liu Xinxiu , Wu Gang , Li Juan , Zhang Liling
Published: December 2019

Rational:

Intravascular large B-cell lymphoma (IVLBCL) is a rare condition with a poor prognosis. The clinical presentation of primary lymphoma of the prostate is non-specific and it is difficult to distinguish from other prostatic diseases. The primary prostate IVLBCL is very rare, the diagnosis and treatment of which remains unclear. We reported a rare case to explore the diagnosis and treatment for the primary prostate IVLBCL.

Patients concerns:

This report described a case of a 71-year-old male diagnosed as primary prostate IVLBCL who presented with prostatic hyperplasia.

Diagnosis:

The patient first visited an outpatient clinic of urinary surgery because of urinary urgency and frequency and was diagnosed as benign prostatic hyperplasia in about January 2010. Four years later, the symptoms worsened quickly within two months. The diagnosis was still prostatic hyperplasia according to the physical examination and imaging. However, histopathology showed IVLBCL of prostate after transurethral resection of the prostate.

Interventions:

With the clear diagnosis of primary prostate stage I IVLBCL, the patient received immunochemotherapy of R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) for 4 cycles and intensity-modulated radiation therapy (IMRT) including the region of prostate with the dose of 45Gy/25f.

Outcomes:

The response was complete remission after all treatment. The last follow-up time of the patient was June 20th, 2019, and no evidence of disease progression was observed. The progression-free survival of the patient was about 49 months until now.

Lessons:

The biopsy of prostate by prostatectomy plays an important role in the diagnosis and removal of the original lesion of primary prostate lymphoma. There is no consensus on therapeutic modalities for the treatment of primary prostate IVLBCL till now. Individual treatments include immunochemotherapy and/or radiotherapy according to the National Comprehensive Cancer Network (NCCN) practice guideline of diffuse large B cell lymphoma (DLBCL) based on the performance status and tumor staging of the patient. Timely and accurate diagnosis as well as the appropriate treatment may improve the clinical outcome.
A case report on the effect of rituximab on pyothorax-associated lymphoma
Authors: Wang Fei , Lan Hai
Published: December 2019

Rationale:

Pyothorax-associated lymphoma (PAL) is a rare type of malignant pleural lymphoma. Most lymphomas are normally discovered around 20 to 50 years after tuberculosis infection. In China, there have been few reports about PAL cases so far. We report a case of a patient, whose tuberculosis and lymphoma were diagnosed concurrently.

Patient concerns:

The patient, a 76-year-old male, was reported to our hospital on March 13, 2015. He had recurrent shortness of breath during the previous 2 years of routine activities solely. His symptoms became more serious which was manifested by edema of lower limbs 1 day before his admission to our hospital.

Diagnoses:

Doctors reached the diagnosis of PAL based on the patient's pathologic cell morphology and immunohistochemistry. The chest computed tomography examination revealed that there were pleural effusions on both sides, and some extent of compressive atelectasis in the lower parts of the inflamed lungs yet without space-occupying lesions. There were multiple small nodules which may be benign in the right upper lung.

Interventions:

The current first-line treatment for diffuse large B-cell lymphoma is the cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) protocol. Given that the patient had cardiac diseases and cardiotoxicity of anthracyclines, doctors decided to adopt rituximab with cyclophosphamide, vincristine, and prednisone chemotherapy without anthracyclines.

Outcomes:

The treatment effect was obvious after one cycle of chemotherapy. The patient's pleural and pericardial effusions were significantly reduced. With the chemotherapy protocol above continuously adopted, pleural and pericardial effusions did not increase in multiple reexaminations on October 25, 2015, February 15, 2016, and August 10, 2016.

Lessons:

Analytical research revealed that chemotherapy with rituximab can increase the complete remission rate of non-Hodgkin lymphoma, reduce the possibility of failure and relapse, and prolong disease-free and overall survival. Moreover, there is no significant increase in adverse drug reactions compared with the effect of chemotherapy with CHOP alone. In the case of this patient, chemotherapy with rituximab was safe and efficacious.
Effects of Cardiovascular Health Shocks on Spouses’ Work and Earnings
Authors: Jeon Sung-Hee , Stepner Michael , Rotermann Michelle , Fransoo Randy , Sanmartin Claudia , Scales Damon C. , Wunsch Hannah , Iwashyna Theodore J. , Garland Allan
Published: December 2019

Background:

Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area.

Objectives:

The objective of this study was to assess how 3 common health shocks, acute myocardial infarction, stroke, and cardiac arrest, influence work and earnings of spouses aged 35–61 years.

Research Design:

This retrospective cohort study of case and control couples used population-based, linked Canadian income tax and hospitalization data from 2005 to 2013.

Subjects:

Case couples comprised 1 partner aged 41–61 years who experienced a health shock in the index year and survived 3 years hence, and a working-age partner. Control couples were matched up to 5:1 on 12 characteristics, with neither experiencing the health shock of interest in the index year.

Measures:

Primary outcome was the change in spousal annual earnings between the year prior and 3 years after the event. Pre-to-post spousal income changes were categorized into 9 levels and compared between case spouses and control spouses by the Pearson χ2 test.

Results:

There were 11,208 matched case couples for acute myocardial infarction, 622 for cardiac arrest, and 2288 for stroke. Overall, case and control spouses experienced similar distributional changes in preevent to postevent earning (all P≥0.27). Heterogeneity analysis indicated that spouses of more severe stroke sufferers ceased working at a higher rate than for control spouses.

Conclusion:

Beyond assessing average values, detailed analysis of changes in spousal earnings after common cardiovascular health shocks did not demonstrate effects attributable to those health shocks.
Adults With Asthma Experience No Increase in Asthma-related Exacerbations When Digital Communication Technology Tools Are Employed to Offset Provider Workload
Authors: Bender Bruce G. , Wagner Nicole M. , Shoup Jo A. , Goodrich Glenn K. , Shetterly Susan M. , Cvietusa Peter J. , Anderson Courtney B. , Xu Stan , Ritzwoller Debra P. , Tacinas Cathy , King Diane K. , Raebel Marsha A.
Published: December 2019

Background:

Challenges to health care efficiency are increasingly addressed with the help of digital communication technology tools (DCTs).

Objective:

The objective of this study was to test whether DCT, compared with Usual Care, can reduce health care clinician burden without increasing asthma-related exacerbations among patients with asthma in a large integrated health care system.

Research Design:

The (Breathewell) program was a pragmatic, randomized trial at (Kaiser Permanente Colorado), where asthma nurses screen patients for poor symptom control when beta2-agonist refill requests came within 60 days of previous fill or in the absence of a controller medication fill within 4 months (beta2-agonist overfill). A total of 14,978 adults with asthma were randomized to Usual Care or 1 of 2 DCT intervention groups (Text/Phone call or Email).

Subjects:

Participants included adults 18 and older with an asthma diagnosis at the time of randomization and no history of chronic obstructive pulmonary disease.

Measures:

Primary outcome measures included asthma-related health care resource utilization (eg, asthma nurse contacts), medication use, and exacerbations.

Results:

A total of 1933 patients had 4337 events which met beta2-agonist overfill criteria. Of the 2874 events in the intervention arm, 1188 (41%) were resolved by DCT contact and did not require additional clinician contact. Asthma medication use and exacerbations over 12 months did not differ among the 3 groups.

Conclusions:

DCT tools can successfully contact adult asthma patients to screen for symptoms and facilitate intervention. The absence of differences in medication fills and health care utilization indicates that the strategic replacement of nursing interventions by digital outreach did not reduce treatment adherence or compromise health care outcomes.
Understanding Geographic Variation in Systemic Overuse Among the Privately Insured
Authors: Oakes Allison H. , Sen Aditi P. , Segal Jodi B.
Published: December 2019

Background:

Medical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions.

Objective:

We tested the association between structural factors of the health care delivery system and regional differences systemic overuse.

Research Design:

We conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and Encounters Database. We calculated a semiannual Johns Hopkins Overuse Index for each of the 375 Metropolitan Statistical Areas in the United States, from January 2011 to June 2015. We fit an ordinary least squares regression to model the Johns Hopkins Overuse Index as a function of regional characteristics of the health care system, adjusted for confounders and time.

Results:

The supply of regional health care resources was associated with systemic overuse in commercially insured beneficiaries. Regional characteristics associated with systemic overuse included number of physicians per 1000 residents (P=0.001) and higher Medicare malpractice geographic price cost index (P<0.001). Regions with a higher density of primary care physicians (P=0.008) and a higher proportion of hospital-based providers (P=0.016) had less systemic overuse. Differences in hospital and insurer market power were inversely associated with systemic overuse.

Conclusions:

Systemic overuse is associated with observable, structural characteristics of the regional health care system. These findings suggest that interventions that aim to improve care efficiency via reductions in overuse should focus on the structural drivers of this phenomenon, rather than on the eradication of individual overused procedures.
Development and Validation of an Administrative Claims-based Measure for All-cause 30-day Risk-standardized Readmissions After Discharge From Inpatient Psychiatric Facilities
Authors: Winterstein Almut G. , Bussing Regina , Goodin Amie , Xu Dandan , Keenan Megan , Turner Kristen , Meyyur Vinitha , Duseja Reena , Campbell Kyle
Published: December 2019

Objective:

The objective of this study was to develop and test a measure that estimates unplanned, 30-day, all-cause risk-standardized readmission rates (RSRRs) after inpatient psychiatric facility (IPF) discharge.

Participants:

We established a retrospective cohort of adults with a principal diagnosis of psychiatric illness or dementia discharged from IPFs to nonacute care settings, using 2012–2013 Medicare fee-for-service claims data.

Measures:

All-cause unplanned readmissions within 3–30 days post-IPF discharge were assessed by constructing then validating a parsimonious logistic regression model of 56 risk factors (selected via empirical data, systematic literature review, clinical expert opinion) for readmission using bootstrapping. RSRRs were calculated from the ratio of predicted versus expected readmission rates for each IPF using hierarchical regression. Measure reliability and validity were assessed via multiple strategies.

Results:

The measure development cohort included 716,174 admissions to 1679 IPFs and 149,475 (20.9%) readmissions. Most readmissions (>80%) had principal diagnoses of mood, schizoaffective or substance use disorders, delirium/dementia, infections or drug/substance poisoning. Facility RSRRs ranged from 11.0% to 35.4%. The risk adjustment model showed good calibration and moderate discrimination similar to other readmission risk models (cstatistic 0.66). Sensitivity analyses solidified the risk modeling approach. The intraclass correlation coefficient of estimated IPF RSRRs was 0.78, indicating good reliability. The measure identified 8.3% of hospitals as having better and 13.4% as having worse RSRRs than the national readmission rate.

Conclusions:

The measure provides an assessment of facility-level quality and insight into risk factors useful for informing preventive interventions. The measure will be included in the Centers for Medicare and Medicaid Services (CMS) Inpatient Psychiatric Quality Reporting program in 2019.
Cholangiocarcinoma in patients with primary sclerosing cholangitis
Authors: Fung Brian M. , Tabibian James H.
Published: December 2019

Purpose of review

Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intrahepatic and/or extrahepatic bile ducts. It is associated with a significantly increased risk of malignancy, particularly cholangiocarcinoma (CCA). In this review, we discuss what is currently known about the epidemiology of and risk factors for CCA in PSC as well as recent advances in its prevention, diagnosis, and surveillance.

Recent findings

An area of major focus has been finding novel biomarkers (in serum, bile, and urine) for CCA. With the advancement of computing power, metabolomic and proteomic approaches, among other methods, may provide enhanced capability for differentiating between benign and malignant bile duct disease. Another area of focus has been the approach to CCA surveillance in PSC; a recent study has found that CCA surveillance in patients with PSC is associated with improved outcomes, including increased survival, thus advocating for its importance.

Despite ongoing advancements in the study of PSC-associated CCA, early diagnosis of CCA remains difficult, treatment options are limited, and prognosis is often consequently poor. Continued research in the development of high-accuracy diagnostic tools, novel biomarkers, and surveillance techniques may help to increase the likelihood of diagnosing CCA at earlier stages, when therapeutic options have the highest likelihood of resulting in cure.