Medicine
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Review Meta Analysis
Reevaluation of Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma: A Meta-Analysis of Randomized Controlled Trials Over the Past 20 Years.
The effect of neoadjuvant chemotherapy on the survival of patients with thoracic esophageal squamous cell carcinomas (ESCCs) remains controversial. The optimal management strategy for resectable ESCCs varies regionally based on local randomized controlled trials. A systematic review and meta-analysis was conducted to re-evaluate this controversial issue. ⋯ Cisplatin and fluorouracil were adopted as neoadjuvant chemotherapy regimens. The role of neoadjuvant chemotherapy for ESCC is worth re-investigating. The design of randomized controlled trials should adopt new chemotherapy regimens as well as define the surgical procedure and the details of the lymphadenectomy.
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Review Meta Analysis
Prognostic Role of Hypothyroidism in Heart Failure: A Meta-Analysis.
Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive. We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. ⋯ However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76). We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.
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Randomized Controlled Trial Multicenter Study
Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database.
The aim of the study was to evaluate preoperative variables predictive of lethal morbidities in critically ill surgical patients at a national level. There is no report of risk stratification for morbidities associated with mortality in critically ill patients with acute diffuse peritonitis (ADP). We examined data from 16,930 patients operated during 2011 and 2012 in 1546 different hospitals for ADP identified in the National Clinical Database of Japan. ⋯ A total of 18 to 29 preoperative variables were selected per morbidity and yielded excellent C-indices for each (septic shock: 0.851; progressive renal insufficiency: 0.878; prolonged ventilation >48 h: 0.849; systemic sepsis: 0.839; CNS morbidities: 0.848; acute renal failure: 0.868; pneumonia: 0.830; and SSI: 0.688). We report the first risk stratification study on lethal morbidities in critically ill patients with ADP using a nationwide surgical database. These risk models will contribute to patient counseling and help predict which patients require more aggressive surgical and novel pharmacological interventions.
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Meta Analysis Observational Study
eNOS Genetic Polymorphisms and Cancer Risk: A Meta-Analysis and a Case-Control Study of Breast Cancer.
The association between endothelial nitric oxide synthase (eNOS) polymorphisms (intron 4a/b, -786T>C and 894G>T) and cancer risk remains elusive. In addition, no studies focused on their associations with the risk of breast cancer in Chinese Han population. Thus, a meta-analysis was conducted to determine the relationship between eNOS polymorphisms and cancer risk, and then a case-control study in Chinese Han population was performed to assess their associations with breast cancer susceptibility. ⋯ In addition, stratified analyses based on pathological type showed that eNOS 894G>T polymorphism was only associated with the risk of infiltrative ductal carcinoma. Stratified analyses by tumor stage showed that eNOS -786T>C polymorphism was only associated with the risk of tumor stage III and IV. In conclusion, our meta-analysis and case-control study suggest that eNOS -786T>C and 894G>T polymorphisms are associated with the increased risk of breast cancer.
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Frequent emergency department (ED) users contribute to a disproportionate number of ED visits that consume a substantial amount of medical resources. Additionally, people with frequent ED visits may be at greater risks of illnesses and injury and are vulnerable to even more severe health events. We conducted, based on a nationally representative sample, a population-based study to estimate the prevalence of frequent ED users among all ED users, and to explore factors associated with frequent ED visits. ⋯ On the contrary, the significant predictors for highly frequent ED visit with greater AOR included hospitalization during the past year (AOR = 3.95), > 12 outpatient visits during the past year (AOR = 2.66), and a history of congestive heart failure (AOR = 2.64) and psychiatric disorders (AOR = 2.35). People admitted and with frequent outpatient visits were at greater risk of frequent ED visit. Because people with a history of various comorbidities were also vulnerable to become frequent ED users, careful management of those comorbidities by clinicians may help further reduce the likelihood of frequent ED visit.