Medicine
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Review Comparative Study
Comparing the Overall Result and Interaction in Aggregate Data Meta-Analysis and Individual Patient Data Meta-Analysis.
The aim of the study was to examine how well aggregate data meta-analyses (ADMAs) and individual patient data meta-analyses (IPDMAs) agree in their overall results and how frequently interactions are detected in IPDMAs and ADMAs. ADMA articles immediately published before the IPDMA and matching the research topic were identified. Agreement in the overall result was achieved if the estimate was in the same direction. ⋯ The IPDMAs conducted 7 times more subgroup analyses on interaction (544 in IPDMAs vs 68 in ADMAs) and identified 14 times more potential interactions (44 in IPDMAs vs 3 in ADMAs). ADMAs will almost always agree with their corresponding IPDMAs in the overall result if greater efforts are made to improve the methodology in conducting ADMAs. The IPDMA is required mostly if interactions are suspected.
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Multicenter Study
Healthy Lifestyle and Risk of Cancer in the European Prospective Investigation Into Cancer and Nutrition Cohort Study.
It has been estimated that at least a third of the most common cancers are related to lifestyle and as such are preventable. Key modifiable lifestyle factors have been individually associated with cancer risk; however, less is known about the combined effects of these factors. This study generated a healthy lifestyle index score (HLIS) to investigate the joint effect of modifiable factors on the risk of overall cancers, alcohol-related cancers, tobacco-related cancers, obesity-related cancers, and reproductive-related cancers. ⋯ There was a 5% lower risk (adjusted HR 0.952, 95% confidence interval (CI): 0.946, 0.958) of all cancers per point score of the index for men and 4% (adjusted HR 0.961, 95% CI: 0.956, 0.966) for women. The fourth versus the second category of the HLIS was associated with a 28% and 24% lower risk for men and women respectively across all cancers, 41% and 33% for alcohol-related, 49% and 46% for tobacco-related, 41% and 26% for obesity-related, and 21% for female reproductive cancers. Findings suggest simple behavior modifications could have a sizeable impact on cancer prevention, especially for men.
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Wisteria floribunda agglutinin-positive human Mac-2 binding protein (WFA-M2BP) is a serologic marker corresponding with degree of hepatic fibrosis. We evaluated its accuracy in assessing hepatic fibrosis and in predicting the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). In a 5-year period (2009-2013), a total of 95 CHB patients with available serum WFA-M2BP assay and transient elastography assessment [to assess liver stiffness (LS)] who had undergone liver biopsy were recruited for retrospective analysis. ⋯ Risk of developing HCC was significantly greater in patients with high WFA-M2BP levels (≥1.8) (adjusted HR = 11.5; P = 0.025). Cumulative incidence rates of HCC were also significantly higher in patients with high (vs. low) levels of WFA-M2BP (log-rank test, P = 0.016). WFA-M2BP determination significantly reflected degree/extent of hepatic fibrosis and independently predicted the risk of developing HCC in patients with CHB.
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Observational Study
Association Between End-Tidal Carbon Dioxide Pressure and Cardiac Output During Fluid Expansion in Operative Patients Depend on the Change of Oxygen Extraction.
In a model of hemorrhagic shock, end-tidal carbon dioxide tension (EtCO2) has been shown to reflect the dependence of oxygen delivery (DO2) and oxygen consumption (VO2) at the onset of shock. The objectives of the present study were to determine whether variations in EtCO2 during volume expansion (VE) are correlated with changes in oxygen extraction (O2ER) and whether EtCO2 has predictive value in this respect. All patients undergoing cardiac surgery admitted to intensive care unit in whom the physician decided to perform VE were included. ⋯ During VE, an increase in EtCO2 did not systematically reflect an increase in CO. Only patients with a high O2ER (i.e., low ScvO2 values) display an increase in EtCO2. EtCO2 changes during fluid challenge predict changes in O2ER.
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Comparative Study
Curative-Intent Aggressive Treatment Improves Survival in Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma and High Comorbidity Index.
For locally advanced head and neck squamous cell carcinoma (HNSCC), therapeutic decisions depend on comorbidity or age. We estimated the treatment outcomes of patients with different Charlson comorbidity index (CCI) scores and ages to determine whether aggressive treatment improves survival. Data from the Taiwan National Health Insurance and cancer registry databases were analyzed, and we included >20-year-old patients with American Joint Committee on Cancer (AJCC) stage III or IV HNSCC (International Classification of Diseases, Ninth Revision, Clinical Modification codes 140.0-148.9) undergoing surgery, chemotherapy (CT), radiotherapy (RT), concurrent chemoradiotherapy (CCRT), sequential CT and RT, or surgery with adjuvant treatment. ⋯ After adjustment for age, sex, and clinical stage, adjusted hazard ratios (95% confidence intervals) of overall death in Group 1 were 0.33 (0.31-0.35), 0.34 (0.31-0.36), and 0.37 (0.28-0.49), and those of all-cause death among patients undergoing curative surgical aggressive treatments were 1.13 (0.82-1.55), 0.67 (0.62-0.73), and 0.49 (0.46-0.53) for CCI scores of ≥10, 5 to 9, and <5, respectively. Aggressive treatments improve survival in elderly (≥65 years) and critically ill HNSCC patients. Curative nonsurgical aggressive treatments including definitive RT or CCRT might be suitable for HNSCC patients with CCI scores ≥10.