Economic consequences of workplace injuries in the United States: Findings from the National Longitudinal Survey of Youth (NLSY79)

Background

This study explored economic consequences of work-related injuries using a longitudinal data source.

Methods

Data were from the National Longitudinal Survey of Youth, 1979 cohort (n = 12,686). Short-term consequences were measured when the injury was reported. "Difference-in-differences" approach was applied to estimate income and wealth disparities between injured and non-injured workers before and after injury. Fixed effects models were used to identify variations over time.

Results

The annual earnings growth was $3,715 (in 2000 dollars) less for workers with DAFW injury and $1,152 less for workers with NDAFW injury compared to non-injured workers during a 10-year follow-up. Lost wages and disability following injury contributed to income loss for injured workers, but the loss was moderated by union membership. After controlling for confounders, income disparities persisted, but family wealth differences did not.

Conclusions

Occupational injuries exacerbate income inequality. Efforts to reduce such disparities should include workplace safety and health enforcement. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

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Serious injury and fatality investigations involving pneumatic nail guns, 1985–2012

Background

This article examines serious and fatal pneumatic nail gun (PNG) injury investigations for workplace, tool design, and human factors relevant to causation and resulting OS&H authorities' responses in terms of citations and penalties.

Methods

The U.S. Occupational Safety and Health Administration (OSHA) database of Fatality and Catastrophe Investigation Summaries (F&CIS) were reviewed (1985–2012) to identify n = 258 PNG accidents.

Results

79.8% of investigations, and 100% of fatalities, occurred in the construction industry. Between 53–71% of injuries appear to have been preventable had a safer sequential trigger tool been used. Citations and monetary penalties were related to injury severity, body part injured, disabling of safety devices, and insufficient personal protective equipment (PPE).

Conclusions

Differences may exist between construction and other industries in investigators interpretations of PNG injury causation and resulting citations/penalties. Violations of PPE standards were penalized most severely, yet the preventive effect of PPE would likely have been less than that of a safer sequential trigger. Am. J. Ind. Med. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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Sleep disturbances and neurotoxicity in workers exposed to hydrocarbons. An observational study from Algeria

Background

Occupational exposure to solvents may lead to neurotoxicity and sleep disturbances. We aimed to investigate the association of occupational exposure to petroleum-derived hydrocarbons with neurotoxicity and sleep disturbance symptoms.

Methods

We included male workers handling/distributing petroleum products (exposed, n = 250) and electricians (non-exposed, n = 250) from two companies in Tlemcen (Algeria). Neurotoxicity was evaluated with the Q-16 questionnaire, and sleep disturbances with the Epworth and the Berlin questionnaires. Multivariable Poisson regression models with robust error variances were applied obtaining risk ratios (RR) and their 95% confidence interval (CI).

Results

Overall, the prevalence of reported neurotoxicity and sleep disturbance symptoms was higher in exposed than in non-exposed workers. Significant adjusted associations were observed for neurotoxicity, snoring, and excessive sleepiness (RR = 2.2, CI: 1.7–2.8; RR = 1.4; CI: 1.1–1.7; RR = 1.3, CI: 1.2–1.5, respectively). No significant associations were observed with the Epworth score.

Conclusions

Our questionnaire-based cross-sectional study suggests that exposure to petroleum-derived hydrocarbons is associated with self-reported sleep disturbances and neurotoxicity symptoms. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

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Case-control study evaluating competing risk factors for angioedema in a high-risk population

Objectives/Hypothesis

Black race is a risk factor for angioedema. The primary aim was to examine the relationship between race–ethnicity and risk factors for angioedema.

Study Design

Using a retrospective case-control study design, data was extracted with the Clinical Looking Glass utility, a data collection and management tool that captures data from electronic medical record systems within the Montefiore Healthcare System. Cases were emergency department (ED) visits with primary or secondary International Classification of Diseases, Ninth Revision, code diagnoses of angioedema in adults aged ≥ 18 years from January 2008 to December 2013 at three Montefiore centers in Bronx, New York. Controls were a random sampling of adult ED visits during the same period.

Methods

In primary analyses, angiotensin-converting enzyme inhibitor (ACE-I) and black race were evaluated for synergy. The influence of different risk factors in the development of angioedema was evaluated using logistic regression models. Finally, race–ethnicity was further explored by evaluating for effect modification by stratification of models by race–ethnicity categories.

Results

There were 1,247 cases and 6,500 controls randomly selected from a larger control pool. ACE-I use (odds ratio [OR] 3.70, 95% confidence interval [CI] 2.98, 4.60), hypertension (OR 1.88, 95% CI 1.55, 2.29), and black race (OR 2.25, 95% CI 1.86, 2.72) were the strongest risk factors. ACE-I use and black race were not synergistic (OR 1.10, 95% CI 0.80, 1.51). Race–ethnicity was an effect modifier for certain risk factors.

Conclusion

Race–ethnicity acts as an effect modifier for particular angioedema risk factors. The two strongest risk factors, ACE-I use and black race, were not synergistic.

Level of Evidence

3b. Laryngoscope, 2016

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Identification of biofilms in post-tympanostomy tube otorrhea

Objectives/Hypothesis

Otitis media is a common problem in the pediatric population. Despite antibiotic therapy, post-tympanostomy otorrhea can be difficult to treat. Biofilms have been shown to play a role in chronic and recurrent otitis media and are implicated in otorrhea. This study investigated both the microbial composition and the presence of biofilm fragments rich in extracellular DNA (eDNA) and the bacterial DNA-binding protein, integration host factor (IHF), in post-tympanostomy tube otorrhea.

Study Design

Clinical samples.

Methods

Institutional review board approval was obtained, and samples were recovered from pediatric patients with tympanostomy tubes and persistent otorrhea for both microbial culture and biofilm analysis. For biofilm assessment, frozen samples were sectioned and then labeled using a rabbit anti-IHF, which was detected with goat anti-rabbit IgG conjugated to AlexaFluor 594. Samples were then counterstained with 4',6-diamidino-2-phenylindole (DAPI) to detect DNA, and images were captured by inverted light microscopy.

Results

Of 15 pediatric otorrhea samples analyzed, nine (60%) contained solids that were positive for labeling of IHF in association with a lattice of eDNA, and 75% yielded positive bacterial cultures. Bacterial culture results included H. influenzae, Methicillin-resistant Staphylococcus aureus, S. pneumoniae, M. catarrhalis, and P. aeruginosa.

Conclusion

Positive labeling of otorrhea solids for eDNA and IHF, in combination with microbiological culture results, indicated that biofilms likely played a key role in chronic otorrhea. Moreover, as a known critical structural component of biofilms, these findings suggest that DNABII proteins in association with eDNA may serve as an important therapeutic target in post-tympanostomy tube otorrhea.

Level of Evidence

NA. Laryngoscope, 2016

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Imaging follow-up study of acute rhinosinusitis

Objectives/Hypothesis

To evaluate with imaging the course of acute rhinosinusitis (ARS) and the associations between paranasal imaging results, symptoms, bony anatomic variations, and culture-proven bacterial ARS.

Study Design

Inception cohort study with 50 conscripts with ARS.

Methods

During a single ARS episode, we collected symptoms daily and took sequential cone-beam computed tomography (CBCT) scans of the paranasal sinuses of the same patients 2 to 3, 5 to 6 and 9 to 10 days after the onset of symptoms. Culture-proven bacterial ARS was verified with maxillary sinus aspiration and bacterial culture at 9 to 10 days.

Results

At 2 to 3 days, 38% of the patients had major abnormalities, 42% had minor abnormalities in their paranasal sinuses, and 68% had an occluded ostiomeatal complex (OMC). At 5 to 6 days and 9 to 10 days, these proportions remained essentially the same. At 2 to 3 days, patients with bacterial ARS had slightly higher CBCT scores than those without bacterial ARS. Later, the CBCT and symptom scores gradually increased in patients with bacterial ARS and decreased in those without bacterial ARS. The CBCT and symptom scores had only a weak correlation (r_s = 0.36), and anatomic variations were not related to development of bacterial ARS.

Conclusions

Paranasal mucosal abnormalities and occlusion of the OMC do not develop gradually during ARS, but are present when symptoms begin and remain fairly constant in most patients both with and without bacterial ARS. This indicates that the spread of the disease process to the paranasal sinuses and obstruction of the OMC may not be etiological factors in the development of bacterial ARS.

Level of Evidence

4 Laryngoscope, 2016

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A systematic review on the surgical outcome of preauricular sinus excision techniques

Objectives/Hypothesis

Preauricular sinuses are benign congenital malformations of preauricular soft tissues. Complete excision using either sinectomy or supra-auricular approach is advised to prevent recurrence. Reported recurrence varies between 0 and 42%. We evaluated which surgical technique resulted in lowest complication and recurrence rates.

Study Design

PubMed, Embase, Scopus, Web of Science.

Methods

Two authors appraised studies on directness of evidence and risk of bias. Original data were extracted and pooled when I² was smaller than 50%. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results

Fourteen high directness of evidence studies were included. Reported complication rates were similar: sinectomy [0–31.4%] and supra-auricular approach (SAA) [0–18.2%]. Pooled recurrence rates showed that sinectomy resulted in significantly (P = .04) more recurrence 5.5% (95% confidence interval [CI] 3.6–8.3%) than SAA 2.2% (95% CI 0.7–7.0). Sinectomy using the microscope resulted in the lowest sinectomy recurrence rates (1.9%). SAA in combination with a Penrose drain resulted in 0% recurrence in revision cases. Drain use resulted in the lowest SAA recurrence rates; however, drain application was not advised due to higher complication rates (frequent wound infection [P = .003] and more [P = .002] and longer [P = .001] compression dressing use).

Conclusion

SAA could be the preferable technique for preauricular sinus removal. If despite evidence, sinectomy is elected over SAA, microscope use can further decrease recurrence rates comparable to SAA levels. Level of included evidence (Ib–IV) indicates the need for a prospective study comparing surgical outcomes between techniques. Laryngoscope, 2016

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Clinical significance of arterial stiffness in idiopathic sudden sensorineural hearing loss

Objectives/Hypothesis

To investigate the clinical significance of arterial stiffness in the development and prognosis of idiopathic sudden sensorineural hearing loss (SSNHL).

Study Design

A prospective case-control study.

Methods

Fifty-four adult patients with idiopathic SSNHL and 54 age- and sex-matched controls were evaluated between January 2014 and May 2015. Arterial stiffness was assessed from brachial-ankle pulse wave velocity (baPWV), and other cardiovascular markers including blood pressure, body mass index, and lipid profiles were determined. The SSNHL patients were divided into two groups, recovery and nonrecovery, according to hearing recovery.

Results

BaPWV was higher in the SSNHL group than in the control group (P = .036), whereas comorbidity, anthropometric characteristics, blood pressure, and lipid profiles were similar. In addition, baPWV was correlated with initial hearing threshold, which indicated the severity of SSNHL (r = 0.38, P = .004). Univariate analysis showed that age, initial hearing threshold, and baPWV were higher in the nonrecovery group than the recovery group (P = .001, P = .004, and P = .007, respectively). There was also a significantly higher prevalence of a history of hypertension or diabetes in the nonrecovery group than in the recovery group. However, multivariate analysis showed that only the initial hearing threshold was associated with hearing recovery (P = .029).

Conclusions

Higher baPWV, representative of arterial stiffness, was associated with development and severity of SSNHL, which supports the hypothesis of a vascular etiology for this disease. Arterial stiffness had limited value in predicting the prognosis of SSNHL.

Level of Evidence

3b. Laryngoscope, 2016

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Detailed Imatinib Metabolite Study in Chronic Myeloid Leukemia

Therapeutic monitoring of drugs is highly useful in individualizing treatment. Imatinib is a chemotherapeutic used in the treatment of chronic myeloid leukemia (CML). Therapeutic monitoring of imatinib and its metabolites results in better clinical outcomes for the patient. However, imatinib metabolization has been poorly studied. With this in mind, Friedecky et al. (2015) used high-resolution mass spectrometry Read the rest of this article

The post Detailed Imatinib Metabolite Study in Chronic Myeloid Leukemia appeared first on Accelerating Science.

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Structural and Conformational Study of the O-Antigenic Portion of the Lipopolysaccharide Isolated from Burkholderia gladioli pv. cocovenenans

Abstract

Lipopolysaccharides (LPSs) are virulence factors that are expressed on the cell surface of Gram-negative bacteria. They represent one of the main traits of bacterial virulence. In this paper, we report the primary structure and the conformational features of the O-chain from the lipopolysaccharide (LPS) produced by Burkholderia gladioli pv. cocovenenans, a bacterium often associated with the mucoralean fungus Rhizopus microsporus var. oligosporus, which is traditionally used in food fermentations. With the aim of understanding the organization of bacterial cell-surface components, we isolated and characterized the following O-antigenic portions of the LPS from B. gladioli pv. cocovenenans: [2)--Rha-(12)--Aco-(12)--Rha-(14)--Gal2Me-(1]_n and [2)--Rha-(12)--Aco-(12)--Rha-(14)--Gal-(1]_n. A distinctive feature of the O-chain is the presence of methylated sugar residues. This contributes to the creation of a hydrophobic shield. The experimental data were confirmed by conformational studies, which showed three-dimensional shapes with different packings and extensions. Such features determine the physicochemical properties of the bacterial envelope, and might contribute to the ability to adapt the membrane surface to the host.

B. gladioli pv. cocovenenas is a plant-pathogenic bacterium isolated from mucoralean fungus Rhizopus microsporus var. oligosporus. We have determined the structure and spatial arrangement of the O-polysaccharide portions of the lipopolysaccharide.

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Differences in the endoscopic detection rates of Barrett’s esophagus using the Japanese and Western criteria: a pilot study

Abstract

Background and aim

Identification of the esophageal gastric junction (EGJ) is of crucial importance for the consistent detection of Barrett's esophagus (BE). In Japan, the distal end of the lower esophageal palisade vessels is used to define the EGJ. However, in Western countries, the EGJ is defined as the proximal margin of the gastric folds. In this prospective study, we compared the variation in endoscopic diagnosis of BE using the Japanese criteria (J-criteria) and the Prague C & M criteria (P-criteria) as a landmark of the EGJ.

Methods

A total of 82 patients were enrolled in this study. The patients were referred to the Veterans Affair Palo Alto Health Care System from May 2008 to July 2008. We assessed the recognition rates of the EGJ and the detection rates of endoscopic BE, first using the J-criteria and later using the P-criteria by the American endoscopists.

Results

Identification rate of EGJ was 87.8 % (72/82) using the J-criteria and 97.5 % (80/82) using the P-criteria (P = 0.008). 28.0 % (23/82) of the cases were endoscopically diagnosed as BE using the J-criteria, whereas 17.0 % (14/82) of the cases were diagnosed as BE using the P-criteria (P = 0.049). There was a significant difference in the detection rates between the J-criteria and P-criteria.

Conclusions

We showed the different ratios in the endoscopic detection of BE using the J-criteria and P-criteria. The difference in the prevalence rate of BE in Japan and Western countries can be partly attributed to differences in the endoscopic diagnose of BE.

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Characteristics and diagnosis of esophageal basaloid squamous cell carcinoma

Abstract

Background

Basaloid squamous cell carcinoma (BSCC) is a relatively rare, malignant disease of the esophagus. The prognosis of patients with BSCC is thought to be poorer than that of typical squamous cell carcinoma (SCC), but the treatment strategy for BSCC is generally the same as that for typical SCC. This study examined the diagnosis, the clinical and pathological characteristics, and the results of therapy in patients with BSCC.

Methods

The medical records for 13 patients with pathologically confirmed esophageal BSCC were extracted. The pretreatment endoscopic diagnosis and the pathological diagnosis after resection were reviewed for each patient, and the histological features and patient outcome were examined. We especially focus on histological difference and endoscopic findings of the 13 patients with BSCC.

Results

Macroscopically, BSCC was mainly visualized as an elevated lesion with normal epithelium on the surface layer which indicated the tumor growth into submucosa. Further pathological examination allowed the 13 BSCC patients to be grouped into 2 groups according to differences in the microscopic appearances of the BSCC cancer cells: a typical BSCC pattern and a pattern similar to that of poorly differentiated SCC. Six of the patients who received an esophagectomy as the primary treatment died, and only 1 patient survived. Two patients who received chemoradiotherapy before an esophagectomy did not develop recurrences. Almost all the patients who died as a result of the recurrence of esophageal cancer had a lymph node recurrence. Prognoses of BSCCs with a pattern similar to that of poorly differentiated SCC without preoperative chemotherapy were poorer than BSCCs with a typical BSCC pattern, while BSCC with a pattern similar to poorly differentiated SCC with preoperative chemotherapy showed good prognoses than BSCC without preoperative chemotherapy.

Conclusions

BSCC esophageal cancer mainly appears as an elevated lesion with submucosal growth, which can be diagnosed preoperatively by understanding of macroscopic characteristics of esophageal BSCC. The outcome of the BSCC patients in the present study was relatively poor, while pretreatment diagnosis of BSCC influences the strategy of treatment and pathological diagnosis including histological difference of BSCC may lead to appropriate treatment and better prognosis of esophageal BSCC.

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Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy

Abstract

Background

We conducted paravertebral block (PVB) for thoracotomy, with epidural anesthesia carried out as usual for laparotomy. To date, there has been no report of combining continuous PVB for thoracotomy and epidural anesthesia for laparotomy after esophagectomy. The aim of this historical study was to evaluate the efficacy of the combination.

Methods

This is a retrospective analysis of 105 patients who underwent transthoracic esophagectomy at our institution from April 2012 to July 2014. Fifty-three patients underwent two epidural catheter placements for thoracotomy and laparotomy from April 2012 to March 2013 (EP group), and 52 underwent PVB for thoracotomy and epidural catheter for laparotomy from April 2013 to July 2014 (PVB group). In both groups, an anesthetic agent was continuously infused until postoperative day 7. PVB was placed by the surgical team at the end of the operation under direct vision.

Results

There was no significant difference between the two groups regarding dosage of an additional analgesic agent. Only one catheter-related complication occurred, in the EP group. The frequency of hypotension in the PVB group was significantly lower than that in the EP group (9.6 and 30.2 %, respectively; P = 0.008). The time to ambulation in the PVB group was significantly shorter than that in the EP group (1.5 ± 0.5 days vs. 1.9 ± 0.9 days; P = 0.007).

Conclusions

Combined PVB for thoracotomy and epidural anesthesia for laparotomy is safe and effective. This method should be considered a useful option for postoperative pain control after esophagectomy.

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Welcome to 2016 and a few words from the New Editor

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Aspirin prevents atrophy of esophageal nitrergic myenteric neurons in a mouse model of chronic Chagas disease

Summary

The consequences of using aspirin (ASA) for the pathogenesis of Chagas disease are unclear. This study evaluated the effects of treatment of Chagas disease with ASA on the esophageal nitrergic myenteric neuron population and esophageal wall in mice. We observed that treatment of chagasic infection with ASA protects the esophageal myenteric neurons from the atrophy caused by the Trypanosoma cruzi infection. The mice were infected with 1300 trypomastigotes of Y strain T. cruzi intraperitoneally. Part of infected mice was treated with ASA from fifth to twelfth day after inoculation. Our data support the hypothesis that eicosanoids given during the acute phase of the chagasic infection may act as immunomodulators aiding the transition to and maintenance of the chronic phase of the disease. Besides, ASA treatment did not provoke alterations in the esophageal wall and the myenteric neurons in infected mice.

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Simple preoperative risk scale accurately predicts perioperative mortality following esophagectomy for malignancy

Summary

Surgery remains one of the major treatment options available to patients with esophageal cancer, with high mortality in certain cohorts. The aim of this study was to develop a simple preoperative risk scale based on patient factors, hospital factors, and tumor pathology to predict the risk of perioperative mortality following esophagectomy for malignancy. The Nationwide Inpatient Sample database was used to create the risk scale. Patients who underwent open or laparoscopic transhiatal and transthoracic esophageal resection were identified using International Classification of Diseases, 9th edition codes. Patients <18 years and those with peritoneal disease were excluded. Multivariate logistic regressions were used to define a predictive model of perioperative mortality and to create a simple risk scale. From 1998 to 2011, a total of 23 751 patients underwent esophagectomy. The observed overall perioperative mortality rate for this cohort was 7.7%. Minimally invasive techniques, and operations performed in higher volume centers were protective, whereas increasing age, comorbidities and diagnosis of squamous cell carcinoma were independent predictors of mortality. Based on this population, a risk scale from 0–16 was created. The calibration revealed a good agreement between the observed and risk scale-predicted probabilities. A set of sensitivity/specificity analyses was then performed to define normal (score 0–7) and high risk (score 8–16) patients for clinical practice. Mortality in patients with a score of 0–7 ranged from 1.3–7.6%, compared with 10.5–34.5% in patients with a score of 8–16. This simple preoperative risk scale may accurately predict the risk of perioperative mortality following esophagectomy for malignancy and can be used as a clinical tool for preoperative counseling.

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Phase I/II study of divided-dose docetaxel, cisplatin and fluorouracil for patients with recurrent or metastatic squamous cell carcinoma of the esophagus

Summary

Squamous cell carcinoma of the esophagus (SCCE) has a poor prognosis compared with other gastrointestinal cancers. Many patients present with locoregional unresectable or metastatic disease at the time of diagnosis. For these patients with metastatic esophageal cancer, chemotherapy is generally indicated. The aim of this phase I/II study was to evaluate the efficacy and safety of the combined use of docetaxel, cisplatin (CDDP) and 5-fluorouracil (5-FU)(DCF) in patients with recurrent/metastatic SCCE. This study adopted divided doses of docetaxel and CDDP in order to reduce the toxicities of the treatment. The dose of docetaxel was escalated using the following protocol in the phase I stage: level 1, 30 mg/m2; level 2, 35 mg/m2 and level 3, 40 mg/m2, which was intravenously infused for 2 hours on days 1 and 8. CDDP was administered at a dose of 12 mg/m2 infused for 4 hours on days 1–5. The 5-FU was administered at a dose of 600 mg/m2 continuously infused from day 1 to 5. This regimen was repeated every 4 weeks. The study subjects were nine patients (phase I) and 48 patients (phase II). The recommended dose was determined as level 3 in phase I. In the phase II stage, the overall response rate was 62.5%, with a complete response rate of 12.5%. The median progression-free survival was 6 months, and the median overall survival was 13 months. Grade 3/4 toxicities of leukopenia, neutropenia and febrile neutropenia occurred in 64.6%, 68.8% and 14.6% of the patients, while grade 3/4 non-hematological toxicities were relatively rare. No treatment-related death was recorded. This modified DCF regimen with divided doses can be a tolerable and useful regimen of definitive chemotherapy for unresectable SCCE because of its high efficacy, although adequate care for severe neutropenia must be administered.

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Wild-type phosphatase and tensin homolog deleted on chromosome 10 improved the sensitivity of cells to rapamycin through regulating phosphorylation of Akt in esophageal squamous cell carcinoma

Summary

Esophageal squamous cell carcinoma (ESCC) is one of the most frequently diagnosed cancers in China, but the etiology and mode of carcinogenesis of this disease remain poorly understood. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN), as a negative regulator of Akt/mTOR pathway, frequently mutates or is inactive in many cancers. Although mTOR has been thought a promising cancer therapeutic target, the sensitivity of tumor cells to rapamycin was still to be revaluated. In this study, we measured the effects of rapamycin on cell proliferation and phosphorylation of Akt in ESCC cells with varying degrees of differentiation. And then, the relationship between PTEN status and the sensitivity of cells to rapamycin was investigated in EC9706 cells with or without wild-type PTEN in vitro and in vivo. The results demonstrated ESCC cells with poor differentiation were insensitive to rapamycin of high concentration and rapamycin obviously promoted the phosphorylation of Akt in these cells, but it had no obvious effects on p-Akt in cells with well differentiation. Also, we showed that wild-type PTEN improved the sensitivity of poor differentiation cells to rapamycin through inhibiting phosphorylation of Akt in vitro and in vivo. This study explored the possible molecular mechanism of some ESCC cells insensitive to rapamycin and provided a measure for treating ESCC patients with PTEN inactivation using mTOR inhibitors.

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External validation of a risk score in the prediction of the mortality after esophagectomy for cancer

Summary

This study was designed as an external evaluation of the Steyerberg score in the prediction of different categories of postoperative mortality after esophagectomy on a large nationwide database of thoracic surgeons. Data collection was obtained from the Epithor national database encompassing the majority of thoracic procedures performed in France. We retrospectively compared the predicted to the observed postoperative 30-day (30DM), 90-day (90DM) and in-hospital mortality (IHM) rate in each decile of equal patient. Patients included in the study were operated for an esophageal cancer and Gastroesophageal junction (GEJ). Steyerberg score was determined according to its logarithmic formula obtained from a sum score including age, comorbidities, neoadjuvant treatment and hospital volume. Deviation of observed from theoretically expected number of deaths was investigated using the calibration test of Hosmer–Lemeshow. Discrimination of the score was determined using the measure of the area under the receiver operating characteristic curve (AUC) of each category of mortality. Over a 9-year period, 1039 consecutive patients underwent an esophagectomy over 42 centers. Among them, 18 centers were considered as intermediate or high-volume institutions, and 24 were low-volume institutions. There were 841 males (81%) with a mean age of 62.3 ± 10 years. Preoperative treatment was allocated to 420 patients (40%). Numbers of comorbidity was: 1 in 261 patients (25%), 2 in 264 patients (25%), 3 in 383 patients (36%) and 4 in 5 patients (1%). The 30DM, 90DM and IHM rate were, respectively, 5.6%, 9.2% and 9.6%. The main causes of postoperative deaths were related to pulmonary complications (44%), complications of the gastric interposition (28%), cardiologic and thromboembolism events (10%). For 30DM, there were significant differences between predicted/observed mortalities in four deciles, whereas there was no significant difference for 90DM and for IHM. In term of calibration, there was a fair agreement of the Steyerberg score with observed 30DM. Predictions were above 20% for seven deciles. Calibration seemed more adequate for 90DM and for IHM. Predictions were above 20% for only three deciles but deviations were not significant. In terms of discrimination, for the 30DM the Steyerberg score overpredicted, the observed mortality rate and AUC was 0.64 (CI 95%: 0.57–0.71). For the 90DM, AUC indicated 0.63 (CI 95%: 0.57–0.68). For the IHM, AUC indicated 0.63 (CI 95%: 0.58–0.68). Steyerberg scoring system seems to be a moderate risk score of the prediction of the IHM and 90DM. This score appears to have a fair discrimination for the 30DM. Nevertheless, because of its simplicity, we believe that this simple predictive score is relevant and transportable to others institution performing such surgery for benchmarking purposes. A reappraisal of the score adapted to current surgical cohort is required.

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Global Head and Neck Cancer Pipeline Review H1 2015 – RD News Mag

Global Head and Neck Cancer Pipeline Review H1 2015 RD News Mag AcuteMarketReports.com has announced the addition of "Global Head and Neck Cancer Pipeline Review H1 2015 "Market Research Report to their Database. The 'Head and Neck Cancer – Pipeline Review, H1 2015′, provides an overview of the Head and … and more »

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Diaphragmatic herniation after thoracolaparoscopic esophagectomy for carcinoma of the esophagus: a report of six cases

Abstract

Diaphragmatic herniation after esophagectomy for carcinoma of the esophagus is a rare postoperative complication. Several recent reports reveal that minimally invasive esophagectomy (MIE) with mediastinal reconstruction is associated with a higher incidence of herniation compared with open esophagectomy. Thoracolaparoscopic esophagectomy (TLE), also called "total MIE", results in fewer peritoneal adhesions around the hiatal region of both the thoracic and abdominal cavities. This may cause abdominal contents to be taken up to the thoracic cavity. We report six cases of diaphragmatic herniation after TLE. Of these, five patients underwent surgical repair and one patient without symptoms is followed up carefully. In TLE, anchoring the gastric conduit to the hiatus is essential for preventing herniation.

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Brain Health as a Key Concept in the Development of Strategies for Delaying Age- Related Cognitive Decline and Alzheimer’s Disease

The post Brain Health as a Key Concept in the Development of Strategies for Delaying Age- Related Cognitive Decline and Alzheimer's Disease appeared first on Welcome to Avens.

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Role of fibroblast growth factor receptors in esophageal squamous cell carcinoma

Abstract

Background

We previously reported that the expression of fibroblast growth factor receptor-like 1 (FGFRL1) was associated with the progression of esophageal squamous cell carcinoma (ESCC). However, the clinical roles of FGFR1, FGFR2, FGFR3, and FGFR4 in ESCC have not yet been examined in detail. Furthermore, it currently remains unclear why FGFRL1 is a prognostic factor for ESCC.

Materials and methods

A squamous cell carcinoma tissue microarray established in Toyama University was used to evaluate the expression of the 4 FGFRs. Sixty-nine ESCC specimens were obtained from patients who had undergone surgery between 1990 and 2008. The immunohistochemical results obtained herein were compared to those for FGFRL1 from our previous study. We also determined whether FGFRL1 bound to other FGFRs that were selected using the tissue microarray analysis.

Results

The frequency of different FGFR overexpression combinations revealed that FGFRL1, FGFR1, and FGFR4 were the predominant types. In contrast to FGFRL1, no association was observed between the expression of each FGFR and patient prognosis. Regarding the combination analysis, patients that co-expressed FGFRL1 and FGFR1 had the worst prognosis, while patients who tested negative for the expression of both FGFRL1 and FGFR4 had the best prognosis. The results of the proximity ligation assay demonstrated that FGFRL1 bound to FGFR1 and FGFR4.

Conclusions

Of the 5 FGFRs examined, the expression of FGFRL1 was the main prognostic factor in ESCC patients. FGFR1 and FGFR4 may be sub-driving factors of ESCC as well as the main targets of the heterodimer of FGFRL1.

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Sustainability, Vol. 8, Pages 40: Research on Steady States of Fuzzy Cognitive Map and its Application in Three-Rivers Ecosystem

Fuzzy Cognitive Map (FCM) offers many advantages such intuitive knowledge representation and fast numerical reasoning ability, etc. It suits modeling and decision-making of dynamic systems. With the aims to effectively help to analyze and control system sustainable evolution, the paper defines the steady states of fixed point and limited cycle of a FCM modeling system. Accordingly, the rules of steady states of the FCM model and the factors influencing the steady states are presented and proved. The Three-Rivers represents a system including population, ecological environment, social development and their relationships. Based on the relationships, the Three-Rivers ecosystem is modeled by FCM and the Three-Rivers ecosystemsustainable evolutionis analyzed bythe rules of the steady states of FCM.

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IJMS, Vol. 17, Pages 32: In Vivo Anti-Tumor Activity and Toxicological Evaluations of Perillaldehyde 8,9-Epoxide, a Derivative of Perillyl Alcohol

Recent studies have revealed the high cytotoxicity of p-menthane derivatives against human tumor cells. In this study, the substance perillaldehyde 8,9-epoxide, a p-menthane class derivative obtained from (S)-(−)-perillyl alcohol, was selected in order to assess antitumor activity against experimental sarcoma 180 tumors. Toxicological effects related to the liver, spleen, kidneys and hematology were evaluated in mice submitted to treatment. The tumor growth inhibition rate was 38.4%, 58.7%, 35.3%, 45.4% and 68.1% at doses of 100 and 200 mg/kg/day for perillaldehyde 8,9-epoxide, perillyl alcohol and 25 mg/kg/day for 5-FU intraperitoneal treatments, respectively. No toxicologically significant effect was found in liver and kidney parameters analyzed in Sarcoma 180-inoculated mice treated with perillaldehyde 8,9-epoxide. Histopathological analyses of the liver, spleen, and kidneys were free from any morphological changes in the organs of the animals treated with perillaldehyde 8,9-epoxide. In conclusion, the data suggest that perillaldehyde 8,9-epoxide possesses significant antitumor activity without systemic toxicity for the tested parameters. By comparison, there was no statistical difference for the antitumor activity between perillaldehyde 8,9-epoxide and perillyl alcohol.

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Sustainability, Vol. 8, Pages 42: The Impact of Restaurants’ Green Supply Chain Practices on Firm Performance

This study investigated crucial green supply chain management (GSCM) practice dimensions and firm performance based on restaurants firms in Taiwan. On the basis of a factor analysis, four green supply chain management dimensions were identified: corporate environment policy, green packing, green product, and economic transport. This study investigated crucial GSCM practice dimensions (including corporate environment policy, packaging waste, economic transport, and product recycling), green capability and organizational performance. The results shown: first, green practices in restaurants in Taiwan have an indirect effect on firm performance through green capability; second, when the ability of suppliers of green and green capability is at a higher degree, it will contribute to organizational performance, namely environmental and economic performance. Finally, green practices could be a key driver of green capability and it should be a priority in restaurants.

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Energies, Vol. 9, Pages 25: A Fuzzy-Logic Power Management Strategy Based on Markov Random Prediction for Hybrid Energy Storage Systems

Over the last few years; issues regarding the use of hybrid energy storage systems (HESSs) in hybrid electric vehicles have been highlighted by the industry and in academic fields. This paper proposes a fuzzy-logic power management strategy based on Markov random prediction for an active parallel battery-UC HESS. The proposed power management strategy; the inputs for which are the vehicle speed; the current electric power demand and the predicted electric power demand; is used to distribute the electrical power between the battery bank and the UC bank. In this way; the battery bank power is limited to a certain range; and the peak and average charge/discharge power of the battery bank and overall loss incurred by the whole HESS are also reduced. Simulations and scaled-down experimental platforms are constructed to verify the proposed power management strategy. The simulations and experimental results demonstrate the advantages; feasibility and effectiveness of the fuzzy-logic power management strategy based on Markov random prediction.

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Sustainability, Vol. 8, Pages 37: VIKOR Technique: A Systematic Review of the State of the Art Literature on Methodologies and Applications

The main objective of this paper is to present a systematic review of the VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) method in several application areas such as sustainability and renewable energy. This study reviewed a total of 176 papers, published in 2004 to 2015, from 83 high-ranking journals; most of which were related to Operational Research, Management Sciences, decision making, sustainability and renewable energy and were extracted from the "Web of Science and Scopus" databases. Papers were classified into 15 main application areas. Furthermore, papers were categorized based on the nationalities of authors, dates of publications, techniques and methods, type of studies, the names of the journals and studies purposes. The results of this study indicated that more papers on VIKOR technique were published in 2013 than in any other year. In addition, 13 papers were published about sustainability and renewable energy fields. Furthermore, VIKOR and fuzzy VIKOR methods, had the first rank in use. Additionally, the Journal of Expert Systems with Applications was the most significant journal in this study, with 27 publications on the topic. Finally, Taiwan had the first rank from 22 nationalities which used VIKOR technique.

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JCM, Vol. 5, Pages 5: An Overview of Insulin Pumps and Glucose Sensors for the Generalist

Continuous subcutaneous insulin, or the insulin pump, has gained popularity and sophistication as a near-physiologic programmable method of insulin delivery that is flexible and lifestyle-friendly. The introduction of continuous monitoring with glucose sensors provides unprecedented access to, and prediction of, a patient's blood glucose levels. Efforts are underway to integrate the two technologies, from "sensor-augmented" and "sensor-driven" pumps to a fully-automated and independent sensing-and-delivery system. Implantable pumps and an early-phase "bionic pancreas" are also in active development. Fine-tuned "pancreas replacement" promises to be one of the many avenues that offers hope for individuals suffering from diabetes. Although endocrinologists and diabetes specialists will continue to maintain expertise in this field, it behooves the primary care physician to have a working knowledge of insulin pumps and sensors to ensure optimal clinical care and decision-making for their patients.

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IJMS, Vol. 17, Pages 59: Binding of Sulpiride to Seric Albumins

The aim of this work was to study the interaction of sulpiride with human serum albumin (HSA) and bovine serum albumin (BSA) through the fluorescence quenching technique. As sulpiride molecules emit fluorescence, we have developed a simple mathematical model to discriminate the quencher fluorescence from the albumin fluorescence in the solution where they interact. Sulpiride is an antipsychotic used in the treatment of several psychiatric disorders. We selectively excited the fluorescence of tryptophan residues with 290 nm wavelength and observed the quenching by titrating HSA and BSA solutions with sulpiride. Stern-Volmer graphs were plotted and quenching constants were estimated. Results showed that sulpiride form complexes with both albumins. Estimated association constants for the interaction sulpiride–HSA were 2.20 (±0.08) × 104 M−1, at 37 °C, and 5.46 (±0.20) × 104 M−1, at 25 °C. Those for the interaction sulpiride-BSA are 0.44 (±0.01) × 104 M−1, at 37 °C and 2.17 (±0.04) × 104 M−1, at 25 °C. The quenching intensity of BSA, which contains two tryptophan residues in the peptide chain, was found to be higher than that of HSA, what suggests that the primary binding site for sulpiride in albumin should be located next to the sub domain IB of the protein structure.

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Extra-nodal natural killer/T cell lymphoma in elderly patients: the impact of aging on clinical outcomes and treatment tolerability

Abstract

Extra-nodal natural killer/T cell lymphoma (ENKTL) is rare in elderly patients, and its clinical course is unclear. The efficacy and tolerability of non-anthracycline-based treatments as a standard regimen in elderly patients have not been fully investigated. This study assessed the impact of aging on clinical outcomes and treatment tolerability. We retrospectively analyzed 51 patients aged ≥60 years who were diagnosed with ENKTL from January 1998 to December 2012. We defined new treatments as non-anthracycline regimens (etoposide, ifosfamide, mesna, cisplatin, and dexamethasone (VIPD); etoposide, ifosfamide, mesna, dexamethasone, and l-asparaginase (VIDL); methotrexate, leucovorin, etoposide, ifosfamide, mesna, dexamethasone, and l-asparaginase (MIDLE); ifosfamide, methotrexate, etoposide, and prednisolone (IMVP16/PD); or methotrexate, leucovorin, etoposide, ifosfamide, mesna, dexamethasone, and l-asparaginase (SMILE), with or without radiation therapy). The median age was 66 years (60–83 years). Twenty patients were diagnosed at advanced stage, and 18 had poor performance status. The overall survival and progression-free survival were 6.7 and 5.2 months, respectively. Clinical outcomes of patients with early disease were superior to those of patients with advanced disease. Among patients who received new treatments, concurrent chemoradiation therapy (CCRT) for localized disease was tolerable, although 37.5 % of patients with advanced disease who received SMILE discontinued chemotherapy due to intolerability. Elderly patients with ENKTL have poor prognostic factors compared to younger patients. In particular, patients with advanced disease have extremely poor prognosis due to inability to tolerate treatment and rapid progression of disease.

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Authors’ response to letter to editor

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Erratum to: Efficacy of Transcatheter Arterial Chemoembolization Followed by Sorafenib for Intermediate/Advanced Hepatocellular Carcinoma in Patients in Japan: A Retrospective Analysis

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Fatal traumatic brain injuries in the construction industry, 2003−2010

Background

Research on fatal work-related traumatic brain injuries (TBIs) is limited. This study describes fatal TBIs in the US construction industry.

Methods

Fatal TBIs were extracted from the Bureau of Labor Statistics Census of Fatal Occupational Injuries.

Results

From 2003 to 2010, 2,210 fatal TBIs occurred in construction at a rate of 2.6 per 100,000 full-time equivalent (FTE) workers. Workers aged 65 years and older had the highest fatal TBI rates among all workers (7.9 per 100,000 FTE workers). Falls were the most frequent injury event (n = 1,269, 57%). Structural iron and steel workers and roofers had the highest fatal TBI rate per 100,000 FTE workers (13.7 and 11.2, respectively). Fall-related TBIs were the leading cause of death in these occupations.

Conclusions

A large percentage of TBIs in the construction industry were due to falls. Emphasis on safety interventions is needed to reduce these fall-related TBIs, especially among vulnerable workers. Am. J. Ind. Med. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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A case of MYH9 disorders caused by a novel mutation (p.K74E)

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Cold antibody autoimmune haemolytic anaemia in a child with diffuse large B cell lymphoma

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Enigmatic meningitis in a patient with T cell lymphoma

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Mortality among World Trade Center rescue and recovery workers, 2002–2011

Background

Rescue and recovery workers responding to the 2001 collapse of the World Trade Center (WTC) sustained exposures to toxic chemicals and have elevated rates of multiple morbidities.

Methods

Using data from the World Trade Center Health Program and the National Death Index for 2002–2011, we examined standardized mortality ratios (SMR) and proportional cancer mortality ratios (PCMR) with indirect standardization for age, sex, race, and calendar year to the U.S. general population, as well as associations between WTC-related environmental exposures and all-cause mortality.

Results

We identified 330 deaths among 28,918 responders (SMR 0.43, 95%CI 0.39–0.48). No cause-specific SMRs were meaningfully elevated. PCMRs were elevated for neoplasms of lymphatic and hematopoietic tissue (PCMR 1.76, 95%CI 1.06–2.75). Mortality hazard ratios showed no linear trend with exposure.

Conclusions

Consistent with a healthy worker effect, all-cause mortality among responders was not elevated. There was no clear association between intensity and duration of exposure and mortality. Surveillance is needed to monitor the proportionally higher cancer mortality attributed to lymphatic/hematopoietic neoplasms. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

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Serious injury and fatality investigations involving pneumatic nail guns, 1985–2012

Background

This article examines serious and fatal pneumatic nail gun (PNG) injury investigations for workplace, tool design, and human factors relevant to causation and resulting OS&H authorities' responses in terms of citations and penalties.

Methods

The U.S. Occupational Safety and Health Administration (OSHA) database of Fatality and Catastrophe Investigation Summaries (F&CIS) were reviewed (1985–2012) to identify n = 258 PNG accidents.

Results

79.8% of investigations, and 100% of fatalities, occurred in the construction industry. Between 53–71% of injuries appear to have been preventable had a safer sequential trigger tool been used. Citations and monetary penalties were related to injury severity, body part injured, disabling of safety devices, and insufficient personal protective equipment (PPE).

Conclusions

Differences may exist between construction and other industries in investigators interpretations of PNG injury causation and resulting citations/penalties. Violations of PPE standards were penalized most severely, yet the preventive effect of PPE would likely have been less than that of a safer sequential trigger. Am. J. Ind. Med. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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Economic consequences of workplace injuries in the United States: Findings from the National Longitudinal Survey of Youth (NLSY79)

Background

This study explored economic consequences of work-related injuries using a longitudinal data source.

Methods

Data were from the National Longitudinal Survey of Youth, 1979 cohort (n = 12,686). Short-term consequences were measured when the injury was reported. "Difference-in-differences" approach was applied to estimate income and wealth disparities between injured and non-injured workers before and after injury. Fixed effects models were used to identify variations over time.

Results

The annual earnings growth was $3,715 (in 2000 dollars) less for workers with DAFW injury and $1,152 less for workers with NDAFW injury compared to non-injured workers during a 10-year follow-up. Lost wages and disability following injury contributed to income loss for injured workers, but the loss was moderated by union membership. After controlling for confounders, income disparities persisted, but family wealth differences did not.

Conclusions

Occupational injuries exacerbate income inequality. Efforts to reduce such disparities should include workplace safety and health enforcement. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

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Microorganisms, Vol. 4, Pages 2: Influence of pH Regulation Mode in Glucose Fermentation on Product Selection and Process Stability

Mixed culture anaerobic fermentation generates a wide range of products from simple sugars, and is potentially an effective process for producing renewable commodity chemicals. However it is difficult to predict product spectrum, and to control the process. One of the key control handles is pH, but the response is commonly dependent on culture history. In this work, we assess the impact of pH regulation mode on the product spectrum. Two regulation modes were applied: in the first, pH was adjusted from 4.5 to 8.5 in progressive steps of 0.5 and in the second, covered the same pH range, but the pH was reset to 5.5 before each change. Acetate, butyrate, and ethanol were produced throughout all pH ranges, but there was a shift from butyrate at pH < 6.5 to ethanol at pH > 6.5, as well as a strong and consistent shift from hydrogen to formate as pH increased. Microbial analysis indicated that progressive pH resulted in dominance by Klebsiella, while reset pH resulted in a bias towards Clostridium spp., particularly at low pH, with higher variance in community between different pH levels. Reset pH was more responsive to changes in pH, and analysis of Gibbs free energy indicated that the reset pH experiments operated closer to thermodynamic equilibrium, particularly with respect to the formate/hydrogen balance. This may indicate that periodically resetting pH conforms better to thermodynamic expectations.

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Acute promyelocytic leukemia following solid organ transplantation

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CD34+ highly enriched allogeneic stem cell transplantation in a patient with mixed phenotype acute leukemia and Fusarium solani sepsis

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Sleep disturbances and neurotoxicity in workers exposed to hydrocarbons. An observational study from Algeria

Background

Occupational exposure to solvents may lead to neurotoxicity and sleep disturbances. We aimed to investigate the association of occupational exposure to petroleum-derived hydrocarbons with neurotoxicity and sleep disturbance symptoms.

Methods

We included male workers handling/distributing petroleum products (exposed, n = 250) and electricians (non-exposed, n = 250) from two companies in Tlemcen (Algeria). Neurotoxicity was evaluated with the Q-16 questionnaire, and sleep disturbances with the Epworth and the Berlin questionnaires. Multivariable Poisson regression models with robust error variances were applied obtaining risk ratios (RR) and their 95% confidence interval (CI).

Results

Overall, the prevalence of reported neurotoxicity and sleep disturbance symptoms was higher in exposed than in non-exposed workers. Significant adjusted associations were observed for neurotoxicity, snoring, and excessive sleepiness (RR = 2.2, CI: 1.7–2.8; RR = 1.4; CI: 1.1–1.7; RR = 1.3, CI: 1.2–1.5, respectively). No significant associations were observed with the Epworth score.

Conclusions

Our questionnaire-based cross-sectional study suggests that exposure to petroleum-derived hydrocarbons is associated with self-reported sleep disturbances and neurotoxicity symptoms. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

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Microorganisms, Vol. 4, Pages 1: Microbial Biofilm Community Variation in Flowing Habitats: Potential Utility as Bioindicators of Postmortem Submersion Intervals

Biofilms are a ubiquitous formation of microbial communities found on surfaces in aqueous environments. These structures have been investigated as biomonitoring indicators for stream heath, and here were used for the potential use in forensic sciences. Biofilm successional development has been proposed as a method to determine the postmortem submersion interval (PMSI) of remains because there are no standard methods for estimating the PMSI and biofilms are ubiquitous in aquatic habitats. We sought to compare the development of epinecrotic (biofilms on Sus scrofa domesticus carcasses) and epilithic (biofilms on unglazed ceramic tiles) communities in two small streams using bacterial automated ribosomal intergenic spacer analysis. Epinecrotic communities were significantly different from epilithic communities even though environmental factors associated with each stream location also had a significant influence on biofilm structure. All communities at both locations exhibited significant succession suggesting that changing communities throughout time is a general characteristic of stream biofilm communities. The implications resulting from this work are that epinecrotic communities have distinctive shifts at the first and second weeks, and therefore the potential to be used in forensic applications by associating successional changes with submersion time to estimate a PMSI. The influence of environmental factors, however, indicates the lack of a successional pattern with the same organisms and a focus on functional diversity may be more applicable in a forensic context.

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Prognostic value of the inverse platelet to lymphocyte ratio (iPLR) in patients with multiple myeloma who were treated up front with a novel agent-containing regimen

Abstract

Recently, reactive thrombosis or platelet to lymphocyte ratio has been reported as a strong predictor of poor prognosis in various types of cancer. However, a study investigating the relationship between platelet counts and thrombopoietic cytokines suggested that low platelet could be important in multiple myeloma (MM), which means platelet count decreased in advanced International Staging System (ISS) stage. Therefore, we developed inverse platelet to lymphocyte ratio (iPLR) and assessed the prognostic value of iPLR in patients with MM. We retrospectively analyzed 283 patients who were treated up front with a novel agent-containing regimen. Patients were classified into three groups based on hazard ratio (HR) according to iPLR: low iPLR (group 1), middle iPLR (group 2), and high iPLR (group 3). Over a median follow-up of 34.8 months, staging by iPLR group had predictive value for progression-free survival (PFS) and overall survival (OS). In addition, staging by iPLR group was a reliable method to predict for survival in patients who presented with renal failure (eGFR < 60 mL/min/1.73 m2) and in elderly patients. Multivariate analyses demonstrated that staging by iPLR group was associated with PFS and OS in patients with MM. In conclusion, this study suggested that iPLR is a simple and reliable inflammatory prognostic factor in the era of novel agents.

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Association of XPD (Lys751Gln) and XRCC1 (Arg280His) gene polymorphisms in myelodysplastic syndrome

Abstract

Myelodysplastic syndromes (MDSs) are heterogeneous hematopoietic disease characterized by ineffective haematopoiesis that frequently transforms into acute leukaemia. Alterations in many individual biologic pathways have been reported in MDS pathophysiology. Disease progression along the MDS, acute myeloid leukemia (AML) continuum is believed to be a consequence of stepwise accumulation of DNA mutations which infers a defect in DNA repair. The present study investigated the association between DNA repair genes (XRCC1, XRCC3, OGG1, XPD and RAD51) and the risk of developing MDS. The study was carried out in 92 primary MDS patients. The genotyping study was carried out by PCR-RFLP technique. We have studied seven single-nucleotide polymorphisms (SNPs) of five DNA repair genes (XRCC1 (Arg194Trp, Arg280His, Arg399Gln), XRCC3, XPD, RAD51 and OGG1). Significantly, a high frequency of DNA repair gene XRCC1 (Arg280His) (p = 0.05) and XPD (Lys751Gln) (p = 0.01) polymorphism was observed in MDS patients compared to controls. The distribution of polymorphisms in MDS subgroups showed a significant association of XRCC1 with RAEB I compared to other subgroup. Though a high frequency of XRCC1 gene polymorphism was observed in farmers and tobacco chewers, it was not statistically significant. Our study suggests that XRCC1 (Arg280His) and XPD polymorphisms are associated with risk of MDS and XRCC1 polymorphism strongly associated with advanced MDS subgroup. Hence, these polymorphisms can be used as a prognostic marker in MDS.

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Can iron overload in patients with lower-risk myelodysplastic syndromes be reduced using erythropoiesis-stimulating agents?

Abstract

Iron overload (IOL) portends inferior outcome in myelodysplastic syndromes (MDS). Erythropoiesis-stimulating agents (ESA) may reduce red blood cell transfusion requirements. MDS patients receiving ESA were reviewed for characteristics, response to ESA by International Working Group 2006 criteria and ferritin levels. Forty-nine patients received an ESA, had ferritin levels available, and were not receiving iron chelation therapy. Baseline characteristics were not significantly different between ESA responders (ER) and non-responders (ENR; P = NS). The median ESA treatment duration was 6.7 (1.5–85.9) months. Twenty-one (43 %) patients had an ESA response. Median ferritin level in ER was pre-ESA, 473 (range 91–2727) and post-ESA, 801 (130–11,164) ng/mL (P = 0.01), and in ENR pre-ESA, 672 (76–3285) and post-ESA, 1423 (431–6593) ng/mL (P < 0.0001). There was a significant association between ESA response, post-ESA hemoglobin ≥100 g/L, and post-ESA ferritin <1000 ng/mL (P = 0.0003 and 0.03, respectively). At a median follow-up of 28 months, the 2-year overall survival for ER and ENR, respectively, were 80 % and 86 % (P = NS). In lower-risk MDS patients responding to ESA, although an expected decrease in ferritin levels over treatment was not seen, ferritin levels increased less than in non-responders. Whether IOL may be reduced by ESA over a longer treatment duration may require analysis of larger numbers of patients.

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PulmCrit- Ultrasound-assisted thrombolysis of PE works. The question is, why?

Ultrasound-assisted catheter-directed thrombolysis is increasingly popular for submassive PE. Unfortunately, the actual mechanism of action of this therapy remains unclear.

EMCrit by Josh Farkas.

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Screening for viral hepatitis prior to rituximab chemotherapy

Abstract

In 2008, the CDC published guidelines recommending screening of all persons undergoing treatment with rituximab to identify persons at risk of hepatitis B virus (HBV) reactivation. We evaluated implementation of this recommendation in veterans, who are at increased risk of HBV, and determined characteristics of those screened. We also evaluated a control setting, rates of hepatitis C virus (HCV) screening among the same rituximab-treated patients. There are no guidelines that recommend HCV screening prior to initiation of rituximab. Medical records of patients receiving rituximab between January 2006 and December 2012 were reviewed according to two time periods: 2006–2008 (period 1, pre-guidelines) and 2009–2012 (period 2, post-guidelines). Patient demographics, concomitant chemotherapy regimen (protocol, dose, duration), treatment indication, risk factors for hepatitis infection (substance abuse, homelessness, human immunodeficiency virus (HIV)), and HBV/HCV screening status were documented. During the study period, 102 patients were treated with rituximab (49 in period 1 and 53 in period 2). During periods 1 and 2, 22 and 32 % of rituximab-treated patients were screened for HBV, respectively (p = 0.375). Treatment during 2009 was the only significant predictor of HBV screening in the adjusted model (p = 0.01). For HCV during periods 1 and 2, 22 and 21 % of patients were screened, respectively (p = 1.00). There were no significant predictors of HCV screening. Rates of screening for HBV among rituximab-treated patients were low, both before and after dissemination of guidelines recommending universal HBV screening of rituximab-treated patients.

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