Non-significant Increase In Incidence Research Articles

The changing epidemiology of pulmonary infection in children and adolescents with cystic fibrosis: an 18-year experience.

The impact of evolving treatment regimens, airway clearance strategies, and antibiotic combinations on the incidence and prevalence of respiratory infection in cystic fibrosis (CF) in children and adolescents remains unclear. The incidence, prevalence, and prescription trends from 2002 to 2019 with 18,339 airway samples were analysed. Staphylococcus aureus [-3.86% (95% CI -5.28-2.43)] showed the largest annual decline in incidence, followed by Haemophilus influenzae [-3.46% (95% CI -4.95-1.96)] and Pseudomonas aeruginosa [-2.80%95% CI (-4.26-1.34)]. Non-tuberculous mycobacteria and Burkholderia cepacia showed a non-significant increase in incidence. A similar pattern of change in prevalence was observed. No change in trend was observed in infants < 2years of age. The mean age of the first isolation of S. aureus (p < 0.001), P. aeruginosa (p < 0.001), H. influenza (p < 0.001), Serratia marcescens (p = 0.006) and Aspergillus fumigatus (p = 0.02) have increased. Nebulised amikacin (+ 3.09 ± 2.24 prescription/year, p = 0.003) and colistin (+ 1.95 ± 0.3 prescriptions/year, p = 0.032) were increasingly prescribed, while tobramycin (-8.46 ± 4.7 prescriptions/year, p < 0.001) showed a decrease in prescription. Dornase alfa and hypertonic saline nebulisation prescription increased by 16.74 ± 4.1 prescriptions/year and 24 ± 4.6 prescriptions/year (p < 0.001). There is a shift in CF among respiratory pathogens and prescriptions which reflects the evolution of cystic fibrosis treatment strategies over time.

Antrum Preservation Versus Antrum Resection in Laparoscopic Sleeve Gastrectomy With Effects on Gastric Emptying, Body Mass Index, and Type II Diabetes Remission in Diabetic Patients With Body Mass Index 30–40 kg/m2: a Randomized Controlled Study

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a widely performed procedure nowadays. There is a controversy on whether antrum resection (AR) or antrum preservation (AP) should be done and if this has an effect on BMI, gastric emptying, and associated medical conditions such as diabetes mellitus (DM).Study DesignThis randomized controlled trial included 56 patients in the AP group and 53 patients in the AR group with BMI 30–40 kg/m2. Weight, BMI, fasting and postprandial blood glucose (FBS and PPBS), HbA1C, oral hypoglycemic drug use, and % gastric emptying by gastric scintigraphy at 30, 60, 90, and 120 min were recorded preoperatively and postoperatively at 3, 6, and 12 months. Postoperative % of total weight loss (TWL) and symptoms of de novo GERD were observed at 3, 6, and 12 months.ResultsThe AR group had significantly lower BMI and HbA1C and higher %TWL than the AP group. There was a significant difference between the two groups regarding % of gastric emptying with the AP group showing higher values at 30, 60, 90, and 120 min. There were no significant differences regarding FBS, PPBS, and oral hypoglycemic use. The AR group had more incidence of GERD symptoms postoperatively yet with no significant difference.ConclusionLSG with antrum resection (2 cm from the pylorus) had significantly less postoperative BMI, higher %TWL, better control of type II DM, and more retention of gastric contents in patients with BMI 30–40 kg/m2 in comparison with LSG with antral preservation with non-significant increase in incidence of GERD symptoms.Graphical abstract

Impact of Omitting Post-Transplant Mini-Methotrexate Doses in Allogeneic Hematopoietic Cell Transplantation: A Single-Center Retrospective Study

Background: Graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Despite its efficacy in combination with calcineurin inhibitors, methotrexate (MTX) may increase the risk of complications such as mucositis and delayed hematopoiesis and can contribute to hepatic and renal toxicities. As a result, doses are often omitted in the setting of treatment-related toxicities. Herein we report outcomes in the setting of omitting doses of mini-MTX (5 mg/m2 IV days 1, 3, 6, and 11) and describe management when these doses are omitted.Methods: This retrospective study identified patients aged 18 years or older who underwent HCT between 1/2008 and 12/2015 with planned GVHD prophylaxis of mini-MTX for four doses with a calcineurin inhibitor (cyclosporine or tacrolimus). Outcomes were compared between patients who had 1-3 doses omitted (group 1) and those who received all four planned doses of mini-MTX (group 2). Differences in baseline characteristics were determined using Chi-square, Fisher's exact, or Wilcoxon Rank-Sum tests as appropriate. Overall and relapse free survival (OS, RFS, respectively) were estimated using the Kaplan-Meier method with differences assessed with a log-rank test. The cumulative incidence method for competing risks was used in estimating non-relapse mortality (NRM), GVHD, as well as GVHD-related mortality, with differences assessed with Gray's test. Relapse was considered a competing risk for NRM while relapse or death were considered competing risks for GVHD. Non-GVHD related death was considered a competing risk for GVHD related mortality. For all analyses related to the number of MTX doses received, a landmark analysis was conducted at day 11 (scheduled date of 4th dose).Results: Of the 188 consecutive patients that were identified, 29 had 1-3 doses of MTX omitted. Baseline characteristics are summarized in Table 1. Notably, no patient in group 1 had ATG (0% vs 10.7%, p = 0.079). Omission of MTX was most commonly due to mucositis (14/29 patients), followed by hyperbilirubinemia, pleural effusions, acute kidney injury, and anasarca/ascites. When any mini-MTX was omitted, the most common strategies were to initiate mycophenolate mofetil (MMF) at 1g IV Q8H (17/29 patients) or corticosteroids (8/29 patients; both MMF and steroids were used in 4 patients). Overall, there was a non-significant increase in the incidence of acute grade 2-4 GVHD when comparing groups 1 and 2 (100-day incidence: 60.7% vs 50.9% respectively, p = 0.501) as well as more severe, grade 3-4 acute GVHD (100-day incidence 28.6% vs. 17%, p = 0.163). Similarly, there was an absolute, non-significant increase in the cumulative incidence of GVHD-related mortality (Table 2). Overall survival and NRM were negatively impacted when MTX was omitted (OS at 12 months: 55.2% vs 73%, respectively, p = 0.015; NRM at 12 months 32.1% vs. 10.1%, respectively, p = 0.003). The most common cause of NRM in both groups was GVHD (group 1: 6/11 patients vs. group 2: 20/29 patients), but organ toxicity was the second leading cause in group 1 (3/11 patients) compared to zero patients in group 2. Other results are summarized in Table 2.Conclusion: While limited by a small number of patients in group 1, it appears our management strategy of introducing an alternative agent (e.g. MMF ± corticosteroids) may ameliorate some of the increased risk of acute GVHD. The patients in group 1 did have worse OS and NRM compared to group 2. The presence of toxicities that caused the omission of MTX may have contributed to these findings. These results appear consistent with recent reports on outcomes, when the planned course of full-dose MTX as GVHD prophylaxis was not administered (Hamilton BK et al., Blood Cancer J 2015). The impact of omitting MTX doses on chronic GVHD incidence in this population will be reported in the future. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Integrating Breast Cancer Early Detection Services Into the Rwandan Health Care System

Background and context: Promoting earlier detection of breast cancer is critical in low-income countries like Rwanda where symptomatic women face long diagnostic delays and most patients present with advanced disease. In these settings, promoting earlier clinical diagnosis should be the initial priority before screening of asymptomatic women. However, there are few data to guide such early detection policies. Aim: Develop a pilot breast cancer early detection program in a rural Rwandan district to evaluate its clinical and health system impact, identify the most effective and feasible roles for staff from each health care system level, and inform national policy. Strategy/Tactics: From 2015-2017 we implemented a training program for 12 randomly selected health centers (HCs) in Burera District, where Butaro Cancer Center of Excellence is located. We trained 1076 community health workers in breast awareness and 127 HC nurses in clinical breast exam (CBE) and management of breast concerns. We trained 9 hospital-level nurses and doctors in diagnostic breast ultrasound to facilitate evaluation of palpable masses. We used pre- and posttests, focus groups, patient surveys, HC registries, and hospital medical records to determine the impact of the training on trainees' knowledge and skills, the volume of patients presenting to health facilities and services provided, cancer detection rate, and clinical stage at diagnosis. Program/Policy process: We met regularly with cancer policy leaders in the Ministry of Health (MOH) and Rwanda Biomedical Centre (RBC) to share findings, identify successes and challenges and build support. Clinicians trained through the project have been invited to serve as national trainers in CBE and contribute to national cancer strategy discussions. Outcomes: Trainings significantly improved knowledge and skills among trainees and increased the number of patients with breast concerns at HCs and the hospital. There was an increase in the proportion of patients with benign disease and the number of needed ultrasounds and biopsies. HCs and the hospital were able to accommodate the increased volume without compromising other services. We had limited power to assess the impact on cancer stage, but noted a nonsignificant increase in incidence of early stage disease among patients referred by intervention HCs. We are now working with MOH/RBC in planning scale-up of the program to other districts and identify a strategy of diagnostic breast ultrasound at the DH level to facilitate evaluation of patients referred from HCs. What was learned: A strategy to promote earlier detection of symptomatic breast cancer was feasible in a rural Rwandan district, effectively strengthened health system capacity to care for patients with breast concerns, and suggests promising impact on patient outcomes. Engagement of key stakeholders in implementation science can help foster evidence-based national cancer control policy.

Incidence and survival trends for medulloblastomas in the United States from 2001 to 2013.

Population-based data examining recent epidemiological trends in medulloblastoma, the most common pediatric brain malignancy, are limited. Therefore, we sought to examine recent population-level trends in medulloblastoma incidence and survival. Central Brain Tumor Registry of the United States (CBTRUS) data were analyzed from 2001 to 2013. Age-adjusted incidence rates (IR) andannual percent changes (APCs) with 95% confidence intervals (CI) were calculated by age, sex, and race. Relative survival rates were calculated by age, sex, and race using Surveillance, Epidemiology and End-Results (SEER) registries; subsets of CBTRUS data. Kaplan-Meier and Cox proportional hazards models were used to examine survival differences. Medulloblastoma incidence remained relatively stable from 2001 to 2013, with minor fluctuations from 2001 to 2009 (APC = 2.2, 95% CI 0.8, 3.5) and 2009-2013 (APC = -4.1, 95% CI -7.5, -0.6). Incidence was highest in patients aged 1-4 years at diagnosis, but patients aged 10-14 years showed increased incidence from 2000 to 2013 (APC = 3.2, 95% CI 0.6, 5.8). Males displayed higher IR relative to females (males: 0.16 vs. females: 0.12), except in patients <1 year-old. Compared to Whites, Blacks displayed a non-significant increase in incidence (APC = 1.7, 95% CI -0.4, 4.0) and in mortality risk (hazard ratio for survival = 0.74; p = 0.09). The current study reports no overall change in medulloblastoma incidence from 2001 to 2013. Male and female patients <1 year-old had equal medulloblastoma incidence rates and poor 5-year relative survival compared to other ages. Non-significant trends in the data suggest disparities in medulloblastoma incidence and survival by race. Thus, analysis of tumor-specific trends by demographic variables can uncover clinically informative trends in cancer burden.

Descriptive Epidemiology of Spinal Meningiomas in the United States.

Cross-sectional study of US cancer registry data. To present the current population-based descriptive epidemiology of spinal meningiomas in the United States. Meningioma is the most common primary spinal tumor, yet there is a paucity of population-based data evaluating incidence according to age, sex, race, and ethnicity. Such data are necessary to assess the burden of spinal meningiomas on varying populations and to inform health care planning and future research. The Central Brain Tumor Registry of the United States, which contains the largest aggregation of population-based data on the incidence of primary central nervous system tumors in the United States, was used. Age-adjusted incidence rates of spinal meningiomas from 2004 to 2010 were calculated by age at diagnosis, sex, race, and ethnicity. Annual percent change was calculated using Joinpoint to characterize temporal trends. From 2004 to 2010, there were 7148 newly diagnosed spinal meningiomas, resulting in an overall age-adjusted incidence of 0.33 per 100,000 population. There was a nonsignificant increase in incidence over time (annual percent change: 0.8%, 95% confidence interval: -1.4 to 3.0). The highest incidence occurred in the 75- to 84-year old age group. Females had a much higher incidence than males (incidence rate ratio: 3.37; P < 0.0001). Asian Pacific Islanders and Caucasians had the highest incidence. Compared with Caucasians, African Americans and American Indian/Alaskan Native individuals had a significantly lower incidence (incidence rate ratio: 0.72, P < 0.0001; 0.52, P = 0.0003, respectively). Non-Hispanics had a significantly lower incidence than Hispanics (incidence rate ratio: 0.81, P < 0.0001). Approximately 1000 spinal meningiomas were diagnosed in the United States per year, and the incidence was relatively stable. Advanced age, female sex, Asian Pacific Islander and Caucasian race, and Hispanic ethnicity were all associated with an increased incidence of spinal meningioma. This study represents the most comprehensive evaluation of population-based descriptive epidemiology of spinal meningiomas in the United States to date. 2.

Emerging trends in hepatocellular carcinoma incidence and mortality.

The rise in incidence of hepatocellular carcinoma (HCC) in the United States has been well documented. The purpose of this analysis was to examine temporal trends in HCC incidence, mortality, and survival within the U.S. population. The Surveillance, Epidemiology, and End Results data were used to examine incidence and incidence-based (IB) mortality in HCC from 1973 to 2011. Secular trends in age-adjusted incidence and IB mortality by sex and cancer stage were characterized using the Joinpoint Regression program. In 1973, HCC incidence was 1.51 cases per 100,000, whereas in 2011, HCC incidence was 6.20 cases per 100,000. Although HCC incidence continues to increase, a slowing of the rate of increase occurs around 2006. In a sensitivity analysis, there was no significant increase in incidence and IB mortality from 2009 to 2011. There was a significant increase in overall median survival from the 1970s to 2000s (2 vs. 8 months; P < 0.001). On multivariable Cox's regression analysis, age, sex, race, tumor grade, stage at diagnosis, lymph/vascular invasion, number of primary tumors, tumor size, and liver transplant were independently associated with mortality. Our results indicate a deceleration in the incidence of HCC around 2006. Since 2009 and for the first time in four decades, there is no increase in IB mortality and incidence rates for HCC in the U.S. population. The nonsignificant increase in incidence and IB mortality in recent years suggest that the peak of the HCC epidemic may be near. A significant survival improvement in HCC was also noted from 1973 to 2010, which seems to be driven by earlier detection of HCC at a curative stage and greater utilization of curative modalities (especially transplant).

Incidence of Soft Tissue Sarcomas in an Italian Area Affected by Illegal Waste Dumping Sites

The aim of the present study was to investigate the possible association between occurrence of soft tissue sarcomas (STS) and residence in an Italian area affected by illegal practices of dumping and setting fire to both hazardous and solid urban wastes. Standardized incidence ratios (SIRs) were computed separately for STS and some specific STS subtypes. The analysis was performed for the total population and for specific age groups, namely, children, adolescents, and adults. In adults, no significant increase in STS was found other than for gastrointestinal stromal tumors in males. A nonsignificant increase in incidence of STS was observed for male children and female adolescents. The results of the present study do not allow conclusions for a causal association. In the absence of previous epidemiological studies on this issue, further investigations are needed.

Investigation of Effect of Nutritional Drink on Chemotherapy-Induced Mucosal Injury and Tumor Growth in an Established Animal Model

Chemotherapy-induced mucositis represents a significant burden to quality of life and healthcare costs, and may be improved through enhanced nutritional status. We first determined the safety of two nutritional drinks (plus placebo), and then potential gut protection in tumor-bearing rats in a model of methotrexate-induced mucositis. In study 1, animals were fed one of two test diets (or placebo or control chow pellets) for a total of 60 days and were monitored daily. All diets were found to be safe to administer. In study 2, after seven days of receiving diets, a Dark Agouti Mammary Adenocarcinoma (DAMA) was transplanted subcutaneously. Ten days after starting diets, animals had 2 mg/kg intramuscular methotrexate administered on two consecutive days; after this time, all animals were given soaked chow. Animals were monitored daily for changes in bodyweight, tumor burden and general health. Animals were killed 10, 12 and 16 days after initially starting diets, and tissues were collected at necropsy. In study 1, animals receiving diets had gained 0.8% and 10.8% of their starting bodyweight after 60 days, placebo animals 4.4%, and animals fed on standard chow had gained 15.1%. In study 2, there was no significant influence of test diet on bodyweight, organ weight, tumor burden or biochemical parameters. Only animals treated with MTX exhibited diarrhea, although animals receiving Diet A and Diet C showed a non-significant increase in incidence of diarrhea. Administration of these nutritional drinks did not improve symptoms of mucositis.

Incidence and mortality trends of head and neck cancer in Croatia in the period 1988–2008

Conclusion: Head and neck cancer (HNC) incidence and mortality trends in men displayed a significant downward trend in Croatia during the study period. No significant changes of incidence and mortality trends were observed in women. Decreasing trends observed in men are similar to other European countries. Further decreases in HNC incidence and mortality could be achieved with more restrictive alcohol and tobacco control policies and adherence to national treatment guidelines. Objective: To describe and interpret trends in incidence and mortality of HNC in Croatia in the period 1988–2008. Methods: HNCs were defined as ICD-10 codes C00-C14, C32. Incidence data were obtained from the Croatian National Cancer Registry, while numbers of deaths were obtained from the WHO Mortality Databank. Joinpoint regression analysis of age-standardized rates (ASR, standard world population) and age-specific rates for 10-year age groups was used to estimate changes in trends of HNC incidence and mortality. Results: HNC incidence and mortality in men declined steadily during the study period (estimated annual percent change (EAPC) of –1.5% and –1.8%, respectively). The most prominent decreases of –5.7% annually for incidence and –9.3% for mortality were observed in the youngest age group, 30–39 years. A non-significant increase in incidence (EAPC 0.9%) and decrease in mortality (EAPC –1.3%) were observed in women.

Time trends in oesophageal cancer incidence in Côte d'Or (France), 1976-93.

The purpose of this study was to examine the change in incidence pattern of oesophageal cancer in the Côte-d'Or region (Burgundy, France). Data from the population-based cancer registry were used to study time trends between 1976 and 1993, according to sex, place of residence, subsite and histology. There was a non-significant increase in incidence of oesophageal cancer, by an average of +1.0% [confidence interval:-0.7; +2.8] per year in men and +2.0% [CI: -3.0; +6.9] in women. In men, variations in incidence were minor according to subsite and place of residence, among the six age groups studied. In contrast, there were important changes among histological types. Rates of squamous cell carcinoma remained stable, but those of adenocarcinoma increased significantly (P < 0.001). They represented 5.6% of known histological types, between 1976 and 1987, and 20.1% in 1991-3. Similar trends were observed in women. This rising incidence of adenocarcinomas, observed later than in the UK or the USA, started in 1987-90 and was particularly pronounced between 1991 and 1993. In view of this sharp increase in incidence of oesophageal adenocarcinomas, research on their aetiological determinants is urgently needed.