Patients In Asian Countries Research Articles

Traditional and Complementary Medicine Use among Cancer Patients in Asian Countries: A Systematic Review and Meta-Analysis.

Globally, cancer patients frequently use T&CM during their treatment for various reasons. The primary concerns regarding the use of T&CM among cancer patients are the potential risks associated with interactions between pharmaceuticals and T&CM, as well as the risk of noncompliance with conventional cancer treatments. Despite the higher prevalence of T&CM use in Asia, driven by cultural, historical, and resource-related factors, no prior review has tried to estimate the prevalence and influencing factors of T&CM use and disclosure among cancer patients in this region. This study aims to examine the prevalence and disclosure rates of T&CM use among cancer patients in Asia to assess various factors influencing its use across different cancer treatment settings in Asia. Systematic research on T&CM use was conducted using four databases (PubMed, EMBASE, Web of Science, and CINAHAL) from inception to January 2023. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS). A random effects model was used to estimate the pooled prevalence of T&CM use, and data analysis was performed using Stata Version 16.0. Among the 4849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). The most commonly used T&CM modalities were herbal medicines and traditional medicine. Females were 22.0% more likely to use T&CM than males. A subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%) and those covered by both national and private insurance (55.8%). The disclosure rate of T&CM use to physicians remains low. Moreover, the factors influencing this disclosure are still insufficiently explored. Since the disclosure of T&CM use is a crucial indicator of patient safety and the quality of cancer treatment prognosis, future research should focus on identifying the determinants of non-disclosure.

Factors Associated with Delayed Presentation to the Hospital Among Breast Cancer Patients in Asian Countries : A Review

Introduction: Breast cancer constituted 13.6% of all reported new cancer in India, with a notable mortality rate due to late presentation. The current research aims to address the extent of delay in presentation to the hospital and the factors that contribute to delayed presentation among breast cancer patients. Methods: Comprehensive literature search was conducted through databases, including PubMed. Both quantitative and Qualitative studies were included. The database search yielded 17 articles and 4 articles were obtained through a manual search. The search was narrowed to article between 2014 to 2024 conducted in Asian countries. Results: A total of 21 studies were included. Among all the factors from patients and providers Knowledge and awareness about breast cancer is the major factor that contributed to delayed presentation to the hospital among breast cancer females as supported by qualitative studies. Across Asia, various other factors also contribute to delayed hospital presentation, including socioeconomic and demographic factors, cultural beliefs and stigma, healthcare system barriers, psychological and family support, use of alternative and complementary medicines, and physical and geographical barriers. Conclusion: Breast cancer is a prevalent cancer. The significant worry lies in delays in seeking medical attention and the tendency for individuals to present at advanced stages.

The Effect of Educational Intervention on Inhaler Technique of Patients in Asian Countries: A Systematic Review

Background: Inhalation therapy is the main line of treatment for the management of various respiratory diseases due to localized delivery and rapid onset of action. Incorrect inhaler technique is very common and subsequently leads to poor disease management. Pharmacist can have a positive impact on patient’s education about proper inhaler technique that can lead to a significant improvement of asthma and COPD management. Objective: The objective of this study was to determine the effectiveness of pharmacist education program on inhaler technique of asthmatic and COPD patients in South Asian countries. The outcome regarding inhalation technique was reviewed and summarized. Methodology: The outcome regarding inhalation technique was reviewed and summarized. For this systematic review, basic electronic academic databases (Scopus, Science Direct, ProQuest, Web of Science and PubMed) were used for the search, along with a manual search on Google Scholar. This systematic review was conducted by following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines. Moreover, utilizing the framework of the PECO-S (Population Exposure Comparison Outcome Study design), various observational studies were recruited for this review. The ZEE tool was utilized to minimize the risk of bias among extracted cross-sectional studies. Inclusion criteria included studies on inhaler using patients of all ages from South Asian countries along with the influence of educational intervention outcomes. Results: Out of 2191 studies, 24 studies meeting the inclusion criteria were included in the current review. All of the included studies were about pharmacist intervention on inhaler technique in South Asian countries. Conclusion: The systematic literature review summarizes the impact of educational intervention provided to inhaler using patients from South Asian countries. It was assessed that patient education and counselling produced improvement in inhalation technique of various devices especially metered dose inhalers. The primary outcome of most the studies was the improvement in inhaler technique assessment and enhanced quality of life. Therefore, inhaler technique education to patients should be made compulsory by the Health-care authorities to enhance compliance and effectiveness of inhalational therapy by avoiding irrational use of inhalers.

Aqueous Extract of Pinellia ternata Breitenbach Tuber Ameliorates Bilateral Common Carotid Artery Stenosis-Induced Cognitive Deficit in Mice by Suppressing the Activation of Astrocytes

Background: The proportion of dementia patients in Asian countries is rapidly increasing, and because vascular dementia is more common than in the West, it is recognized as important as Alzheimer’s disease. Purpose: The aim of this study was to verify the benefits of Pinellia ternata Breitenbach tuber aqueous extract (PTex) in improving cognitive function and reducing inflammation in brain damage resulting from bilateral common carotid artery stenosis (BCAS). Materials and methods: Four groups of five C57BL/6 male mice each were randomly assigned (a sham group, a BCAS surgery group, and two experimental groups that received PTex concentrations of 25 and 50 mL/kg, respectively). Measuring behavioral learning and memory, the two concentrations of the extract were given orally three times a week for six weeks following BCAS surgery. Furthermore, the inflammatory response in the cerebral cortex was observed, and RNA sequencing analysis was carried out. Results: The novel object recognition test revealed that the PTex-50-treated group had improved cognitive function, and the anti-inflammatory effect was confirmed by immunofluorescence staining of brain tissue. Proteins such as Apob, Shh, Dscc1, Cdc45, and Cdc6 were identified through protein-protein interaction network analysis as having a beneficial effect on BCAS-induced cognitive deficit. Conclusion: Results show that PTex-50 was found to have a beneficial effect on BCAS-induced cognitive deficit.

Comparison of on-scene Glasgow Coma Scale with GCS-motor for prediction of 30-day mortality and functional outcomes of patients with trauma in Asia.

This study compared the on-scene Glasgow Coma Scale (GCS) and the GCS-motor (GCS-M) for predictive accuracy of mortality and severe disability using a large, multicenter population of trauma patients in Asian countries. To compare the ability of the prehospital GCS and GCS-M to predict 30-day mortality and severe disability in trauma patients. We used the Pan-Asia Trauma Outcomes Study registry to enroll all trauma patients >18 years of age who presented to hospitals via emergency medical services from 1 January 2016 to November 30, 2018. A total of 16,218 patients were included in the analysis of 30-day mortality and 11 653 patients in the analysis of functional outcomes. The primary outcome was 30-day mortality after injury, and the secondary outcome was severe disability at discharge defined as a Modified Rankin Scale (MRS) score ≥4. Areas under the receiver operating characteristic curve (AUROCs) were compared between GCS and GCS-M for these outcomes. Patients with and without traumatic brain injury (TBI) were analyzed separately. The predictive discrimination ability of logistic regression models for outcomes (30-day mortality and MRS) between GCS and GCS-M is illustrated using AUROCs. The primary outcome for 30-day mortality was 1.04% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.917 (0.887-0.946) vs. GCS-M:0.907 (0.875-0.938), P = 0.155. The secondary outcome for poor functional outcome (MRS ≥ 4) was 12.4% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.617 (0.597-0.637) vs. GCS-M: 0.613 (0.593-0.633), P = 0.616. The subgroup analyses of patients with and without TBI demonstrated consistent discrimination ability between the GCS and GCS-M. The AUROC values of the GCS vs. GCS-M models for 30-day mortality and poor functional outcome were 0.92 (0.821-1.0) vs. 0.92 (0.824-1.0) ( P = 0.64) and 0.75 (0.72-0.78) vs. 0.74 (0.717-0.758) ( P = 0.21), respectively. In the prehospital setting, on-scene GCS-M was comparable to GCS in predicting 30-day mortality and poor functional outcomes among patients with trauma, whether or not there was a TBI.

#3420 CLINICAL CHARACTERISTICS AND PRIMARY OUTCOMES OF PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND CENTRAL DIABETES INSIPIDUS

Abstract Background and Aims Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by systemic small-vessel vasculitis and may rarely present as central diabetes insipidus (CDI). AAV-associated CDI should be recognized to avoid unnecessary biopsies of the pituitary gland and minimize the risk of irreversible loss of pituitary function. In this study, we aimed to determine the clinical characteristics and prognosis of patients with AAV-associated CDI. Method This was a nested case-control study where AAV patients with CDI at the Peking Union Medical College Hospital were followed from January 2012 to April 2022. Case-control matching with AAV patients without CDI was performed (1:2), and participants were matched by age, sex, and AAV classification. We collected clinical data every 3–6 months and conducted a literature review using PubMed to identify relevant articles published from 1983–2022. Results Among 1203 hospitalized AAV patients, 16 patients with CDI were included (1.3%). The average age was 49 years, and men accounted for 56.3%. Granulomatosis with polyangiitis (GPA) accounted for 87.5% of patients. AAV patients with CDI had more ear, nose, and throat (ENT) (81.3%) involvement and less renal impairment than those in the control group (P<0.05). After a mean follow-up of four years, 50% of patients were in remission, 37.5% relapsed, and 12.5% died. Our literature review suggested that patients in Asian countries tend to be older men and have higher MPO-ANCA positivity than those in European countries. Furthermore, PR3-ANCA positivity may predict disease recurrence. Conclusion AAV patients with CDI had more ENT involvement and a higher eGFR. MPO-ANCA positivity is more commonly observed in Asian countries than in European countries, and PR3-ANCA positivity may predict recurrence.

Clinical characteristics and primary outcomes of patients with ANCA-associated vasculitis and central diabetes insipidus.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by systemic small-vessel vasculitis and may rarely present as central diabetes insipidus (CDI). In this study, we aimed to determine the clinical characteristics and prognosis of patients with AAV-associated CDI. This was a nested case-control study where AAV patients with CDI at the Peking Union Medical College Hospital were followed from January 2012 to April 2022. Case-control matching with AAV patients without CDI was performed (1:5), and participants were matched by age, sex, and AAV classification. We collected clinical data every 3-6 months and conducted a literature review using PubMed to identify relevant articles published from 1983-2022. Among 1203 hospitalized AAV patients, 16 patients with CDI were included (1.3%). The average age was 49 years, and men accounted for 56.3%. Granulomatosis with polyangiitis (GPA) accounted for 87.5% of patients. AAV patients with CDI had more ear, nose, and throat (ENT) (81.3%) involvement and less renal impairment than those in the control group (P<0.05). After a mean follow-up of four years, 50% of patients were in remission from AAV, 37.5% relapsed, and 12.5% died. Our literature review suggested that patients in Asian countries tend to be older men and have higher myeloperoxidase (MPO-ANCA) positivity than those in Western countries. Furthermore, proteinase 3 (PR3-ANCA) positivity may predict disease recurrence. AAV patients with CDI had more ENT involvement and a higher eGFR. MPO-ANCA positivity is more commonly observed in Asian countries than Western countries, and PR3-ANCA positivity may predict recurrence.

PCR256 Humanistic Burden and Prevalence of Mental Conditions Among COVID-19 Patients in Japan and China

The COVID-19 pandemic results in widespread health, economic, and social disruptions. It is therefore important to understand the multifaceted effects of COVID-19, including the humanistic burden and impact on mental conditions. This study aims to assess the humanistic burden and prevalence of mental conditions among COVID-19 patients in Asian countries. This study utilized the Internet-based National Health and Wellness Survey (NHWS) conducted in Japan and China. We included respondents in surveys conducted after the COVID-19 outbreak: the 2021 Japan NHWS (n=30,015) and the 2020 China NHWS (n=20,051). COVID-19 patients were identified based on self-reported physician diagnosis. A subset of non-COVID respondents was selected using 1:4 propensity score matching. For each country, demographic characteristics, Health-related Quality of Life (HRQoL), work productivity and activity impairment (WPAI), and prevalence of emotional and mental conditions were compared between COVID-19 patients and selected controls using bivariate analyses. In both countries, COVID-19 patients had statistically significantly lower HRQoL and higher WPAI compared to selected controls on all measures we examined (P<0.01). A higher proportion of COVID-19 patients exhibited symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] ≥10: Japan: 24.3% vs. 12.4%; China: 66.4% vs 18.2%) or anxiety (General Anxiety Disorder-7 [GAD-7] ≥10: Japan: 17.5% vs. 9.4%; China: 40.1% vs 8.2%)) in both countries. COVID-19 patients reported significantly higher total work productivity impairment compared to non-COVID respondents (Japan: 37.3% vs. 20.4%; China: 63.9% vs. 27.5%, p<0.001). Increased rates of emotional and mental conditions (e.g., bipolar disorder, depression, and schizophrenia) were also observed in COVID-19 patients in both countries (P<0.05). This study demonstrated a substantial impact of COVID-19 on HRQoL, WPAI, and mental conditions in both Japan and China. COVID-19 patients experienced significantly worse HRQoL and WPAI, as well as an elevated rate of mental conditions than the non-COVID population.

Real-World Treatment Patterns and Outcomes of Patients with Newly Diagnosed Multiple Myeloma: An Analysis Using National Health Insurance Service Database

Introduction: Available treatments for multiple myeloma (MM) have improved rapidly in recent years. However, due to huge disparities in economy, healthcare infrastructure, and accessibility to new drugs, there are big barriers to provide optimal treatment for MM patients in Asian countries. Until now, there are few data on treatment patterns for MM in real practice setting of Asian countries. In terms of continuous improvement of MM management, it is necessary to ascertain the treatment patterns for achieving optimal treatment. Therefore, we investigated the actual treatment patterns and outcomes of MM patients in Korea using the National Health Insurance Service (NHIS) database. Methods: Newly diagnosed MM patients were identified from the Korean NHIS database between 1st January 2010 to 31st December 2018. Patients had diagnosis with MM (ICD-10 codes C90.0) confirmed with rare and intractable disease registration program. Patients that received at least one stem cell transplantation (SCT) were classified into SCT patients and those without SCT to non-SCT patients. SCT patients and non SCT patients were divided into before and after 1st October 2015 (reimbursement date of bortezomib/dexamethasone [Vd], bortezomib/thalidomide/dexamethasone [VTd] regimens), and 1st December 2017 (reimbursement date of lenalidomide/dexamethasone [Rd] regimen) respectively. MM treatment was defined to start from the first prescription claim including MM treatment following the diagnosis index date, and the therapies within 14-days period from the first date of each line of therapy (LOT) were considered to constitute the treatment regimen of the respective LOT. When a new MM therapy that was not part of the prior LOT appeared in the prescription claim, LOT was considered to advance to the next LOT. Treatment duration, and treatment-free interval times between LOTs were estimated up to 5th LOT. Median overall survival (OS) was assessed by Kaplan Meier. Comparison between groups was evaluated by Log rank and Wilcoxon test. Results: The study population included total of 9,986 newly diagnosed MM patients, 7,501 non-SCT and 2,485 SCT for baseline analyses. Incidence of MM gradually increased by 5.7% of an average annual percent change, from 841 in 2010 to 1,309 in 2018. The mean age of the non-SCT group was older than the SCT group (71.6±9.4 vs 56.7±6.7). The proportion of patients aged <65 was 36.9% and ≥65 was 63.1%. Regardless of SCT eligibility (<65 years), 24.9% of MM patients received SCT. Of the patient eligible for SCT, 62.0% received SCT. Those 8,367 patients (non-SCT:5,925 / SCT:2,442) with at least ≥1 prescription claims with MM treatment after index date were included for treatment pattern analyses. The proportion of patients advancing to each subsequent LOT was higher across all LOT for SCT patients (range, 44%-58%) than non-SCT patients (range, 35%-44%) and decreased with each line. Higher proportion of patients remained to receive 5th LOT in SCT patients than non-SCT (8% vs 3%). Treatment duration and treatment-free interval between LOTs decreased as the LOTs advanced in both SCT and non-SCT patients. Treatment-free interval was the longest after the 1st LOT in SCT patients which was 17.7 months (Fig. 1). The most common 1st LOT treatment regimen for the non-SCT patients was bortezomib/melphalan/prednisolone and for the SCT patients, thalidomide/dexamethasone was mostly used for induction therapy in the 1st LOT. This trend changed as new regimens were available by reimbursement in the 1st LOT: for SCT patients, to VTd; and for non-SCT patients, to Rd. The median OS of all patients was 3.36 years (95% CI: 3.22-3.50). The median OS of the SCT patients was significantly longer with median OS of 7.04 years (95% CI: 6.49-8.11) compared to 2.32 years (95% CI: 2.22-2.44) for the non-SCT patients (p<0.0001). When stratified by age and SCT, SCT patients of younger age (< 65 years) had the longest median OS of 7.10 years (95% CI: 6.56-8.20) (Fig. 2). OS was significantly improved for the SCT group after the reimbursement of Vd and VTd in the 1st LOT (p=0.0019). Conclusions: This real-world data suggests that MM treatment evolves rapidly following the reimbursement of new novel drugs, to treat patients with the most optimal treatment available. And these results show that the OS improves as new novel drugs are incorporated to the treatment. Also, SCT remains an essential treatment providing OS benefit. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Exploring Stroke Patients' Needs after Discharge from Rehabilitation Centres: Meta-Ethnography.

Healthcare providers must consider stroke survivors needs in order to enable a good quality of life after stroke. This review aimed to investigate the perceived needs of the stroke survivors across various domains of care following their discharge from hospital. A meta-ethnographic review of qualitative studies that reported needs of stroke patients after discharge from rehabilitation services was conducted. Main searches were conducted on the following electronic databases: Ovid Medline (1946 to 2021), CINAHL plus (EBSCO), AMED (EBSCO), PsycINFO (1967 to 2021), the Cochrane Library, and PubMed in June 2022. Main outcomes were related to stroke survivors’ views, experiences, and preferences on physical, psychological, social, rehabilitation needs, and other identified needs. Twenty-seven studies were included in the final analysis. The findings show that existing rehabilitation provision for stroke survivors does not address the long-term needs of stroke survivors. Two main issues were revealed concerning the unmet needs of stroke survivors: (1) a lack of information availability and suitability and (2) inadequacy of care and services. It is crucial to further investigate the needs of patients in Asian countries and the Middle East as there is very limited understanding of patients’ needs in the community in these regions.

SY07-4 History and future of oncology early phase global clinical development in Asia

First-in-human (FIH) clinical trials in oncology are highly complex and can only be conducted at a globally small number of highly specialized and qualified hospitals. Historically, early clinical data on new drugs oftentimes had to be generated in national trials, conducted after the global FIH trial. This led to unnecessary delays in getting access to new innovative drugs for patients in Asian countries.

CO101 A Systematic Literature Review of Randomized Controlled Trials Reporting Efficacy and Safety of Treatments in Patients with Advanced Prostate Cancer in Asian Countries

10.1016/j.jaip.2022.01.038The lack of high-level evidence for prostate cancer (PC) treatment in Asian population may limit the ability to adequately manage advanced PC. We conducted a systematic literature review (SLR) to evaluate the efficacy and safety of treatments available in advanced PC patients in Asian countries.

Association between the Platelet-Derived Growth Factor/Platelet-Derived Growth Factor Receptor System and Risk of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

This research examines the association between the platelet-derived growth factor/platelet-derived growth factor receptor (PDGF/PDGFR) system and rheumatoid arthritis (RA) susceptibility through a comprehensive search of the PubMed database to study the expression of the PDGF/PDGFR system in RA. Review Manager software version 5.3 was used for statistical analysis. Six eligible studies published in the English language were included, including 108 rheumatoid arthritis cases and 85 controls with the corresponding 126 and 97 tests, respectively, relating the expression of the PDGF/PDGFR system to the risk of RA. The overall results indicated a significant association between the PDGF/PDGFR system expression and RA (OR = 5.25, 95% CI: 3.00-9.18, p < 00001), RA patients in Asian countries (OR = 4.13, 95% CI = 2.04-8.39, p < 0.0001) and in Western countries (OR = 9.18, 95% CI = 2.04-8.39, p = 0.03), and only PDGF expression in RA patients (OR = 5.28, 95% CI = 2.73-10.21, p < 0.00001). Thus, only the PDGFR expression was insignificantly associated with RA susceptibility (OR = 9.25, 95% CI = 0.63-136.30, p = 0.11). Hence, the PDGF/PDGFR system most likely contributes to susceptibility to RA.

Inflammatory bowel disease and risk of urinary cancers: a systematic review and pooled analysis of population-based studies.

BackgroundThe aim of this study is to elucidate the risk of urologic cancers in patients with Crohn’s disease (CD) and ulcerative colitis (UC).MethodsElectronic databases including PubMed, the Cochrane Library, Embase and Web of Science, and manual retrieval were conducted from inception to June 2020. Two reviewers independently searched the above databases and selected the studies using prespecified standardized criteria. The Newcastle-Ottawa Scale was used to assess the risk of bias in the included studies, and this meta-analysis was completed by STATA version 14.2.ResultsA total of 12 cohort studies and 4 case-control studies were included in this meta-analysis. Overall, patients with inflammatory bowel disease (IBD) were at significantly increased risk of renal cancer (RCa) [standardized incidence ratio (SIR): 1.53; 95% confidence interval (CI): 1.25–1.80; I2=42.4%], but not at increased risk of prostate cancer (PCa), bladder cancer (BCa) and male genital cancer. In the subgroup analysis, CD patients had a significantly higher RCa risk (SIR: 1.95; 95% CI: 1.45–2.44; I2=39.9%). Besides, CD patients seemed to be at borderline significantly increased risks of PCa (SIR: 1.07; 95% CI: 0.93–1.20; I2=15.1%) and BCa (SIR:1.19; 95% CI: 0.94–1.44; I2=0%), and UC patients seemed to be at borderline significantly increased risks of RCa (SIR:1.31; 95% CI: 0.94–1.67; I2=48.0%) and PCa (SIR: 1.13; 95% CI: 0.93–1.33; I2=73.5%). Notably, we observed that IBD patients in Eastern countries have significantly increased PCa risk (SIR: 2.66; 95% CI: 1.52–3.81; I2=13.6%), especially for UC patients (SIR: 3.01; 95% CI: 1.75–4.27; I2=0.0%).ConclusionsOur findings indicate that IBD patients with special reference to CD patients increase the risk of RCa. Besides, IBD patients in Asian countries have significantly increased risk of PCa, especially for UC patients. Further studies are warranted to elucidate the potential mechanism of RCa associated with IBD and the differences of the risk of urinary cancers between Eastern and Western countries.

The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP). Acid-suppression drugs (ACDs) are widely used in SAP patients in Asian countries. However, the impact of ACDs on duodenal microbiota during the early phase of SAP is still unknown. This randomized controlled clinical trial evaluated the impacts of esomeprazole (Eso), one of ACDs on duodenal microbiota during the first week of SAP with duodenal aspirates culture and 16sRNA Illumina sequencing analysis. 66 patients were randomized as 1:1 ratio into Eso group (Eso 40 mg/day) and Eso-N group (no Eso). The occurrence of duodenal bacterial overgrowth (DBO) was significantly higher in Eso group (about 85%) than that in Eso-N group (about 42%). The duodenal microbiota of the SAP patients shifted away from that of the normal control. There were differences between the Eso-N and Eso groups including enriched abundances of the class Negativicutes, order Selenomonadales and genus Veillonella. Acid suppression significantly increased incidence of Candida oesophagitis (CE) by 8-folds but did not increase other infectious events. In conclusion, acid suppression greatly increased the occurrence of DBO, duodenal dysbiosis and CE during the first week of SAP. Restrictive use of acid-suppressing medications might be helpful to reduce CE and potential risk of pancreatic infection in SAP patients.Trial registration: Chictr.org, ChiCTR-IPR-16008301, Registered April 18 2016, http://www.chictr.org.cn/showproj.aspx?proj=14089.

The clinical characteristics of East Asian patients with Birt-Hogg-Dubé syndrome.

BackgroundBirt-Hogg-Dube (BHD) syndrome is an autosomal dominant disease that has been characterized by skin lesions, multiple pulmonary cysts, spontaneous pneumothorax, and renal tumors, but the patients in Asian countries may show fewer symptoms. We aimed to explore and summarize the clinical features of BHD patients in East Asia to facilitate early diagnosis and timely interventions.MethodsWe collected and analyzed the clinical data of patients diagnosed with BHD in our hospital by reviewing medical records. We performed a systematic literature search regarding the presenting clinical features in BHD patients from China, Japan, and Korea and then reviewed the publications that were identified.ResultsIn our hospital, 10 patients were diagnosed with BHD from April 2015 to September 2019. After reviewing the literature, we recruited 38 articles, including 12, 20, and 6 reports from China, Japan, and Korea, respectively. A total of 166 patients were included in this study, and 100 of them (60.2%) were females. Multiple pulmonary cysts were present in 145 patients (87.3%), and 124 patients (74.7%) had a history of pneumothorax on at least one occasion. Skin biopsy confirmed fibrofolliculomas (FFs) alone in 22 patients (13.3%), trichodiscomas (TDs) alone in 3 patients (1.8%), and both FFs and TDs in 7 patients (4.2%). Renal carcinoma only occurred in 12 (7.2%) patients. The most frequent genetic mutations in East Asian patients were c.1285delC on exon 11 (18.4%), c.1285dupC on exon 11 (18.4%), and c.1347_1353dupCCACCCT on exon 12 (8.2%).ConclusionsOur findings suggested that pulmonary cysts are the most frequent radiological findings, and pneumothorax is the most common symptom in East Asian patients with BHD, and that skin lesions and kidney involvement are less frequent. To make an early diagnosis and minimize the severity of complications, careful observation, and timely genetic examination of the FLCN gene is essential.

A Prospective International Study on Safety and Efficacy of Hypofractionated Radiotherapy for Post-Operative Breast Cancer Patients in Asian Countries

A Prospective International Study on Safety and Efficacy of Hypofractionated Radiotherapy for Post-Operative Breast Cancer Patients in Asian Countries

Concomitant botanical medicine use among patients participating in commercial prostate cancer trials

ObjectivesPatients with cancer frequently use botanical medications. The concomitant use of such medications by patients on commercial trials has not been well-described, despite the importance of these trials for evaluating the safety and efficacy of new agents. We sought to describe the use of botanical medications taken by patients with prostate cancer enrolled on global commercial trials. DesignRetrospective study. SettingRegulatory repository of commercial clinical trial data. InterventionsAnti-cancer therapy. Main outcome measuresBotanical and medication use data were pooled across six international commercial randomized trials for metastatic prostate cancer with detailed information on medication and indications. Botanical products were considered to have potential for drug interaction if they led to a change in drug exposure in human trials. Potential for interaction was ascertained by PubMed review. Descriptive statistics were used for analysis. ResultsOf 7318 enrolled patients, 700 (10 %) reported botanical use at any time and 653 (9%) reported use of botanical products while on trial. Nearly half of botanical product types were not classified by plant (43 %). The highest proportion of botanical use was among patients in Asian countries (32 %), followed by patients in North America (13 %). Eighty-six different types of botanical products were used; of these, nineteen had a patient-reported anti-cancer indication. ConclusionsBotanical medicine use among patients with prostate cancer in commercial trials is moderate, although it varies by region. Practitioners should be aware of the use of botanical interventions in a clinical trial context.

Efficacy of Statin/Ezetimibe for Secondary Preventionof Atherosclerotic Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Several clinical trials have investigated the effect of statin/ezetimibe combination therapy on secondary prevention of atherosclerotic cardiovascular disease (ASCVD)in the Asian population. This study aimed to summarize study results regarding the effect of statin/ezetimibe combination therapy on lipid parameters and highly sensitive C-reactive protein (HsCRP) biomarkers in ASCVD patients from Asian countries. We searched the PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar databases for relevant papers published from 2008 to June 2020. We included randomized controlled trials (RCTs) that (1) were conducted in ASCVD patients in Asian countries; (2) examined the effects of statin/ezetimibe combination therapies compared with a control group; and (3) reported sufficient data on lipid parameters and HsCRP biomarkers. The results were reported as weighted mean differences (WMDs) with 95% confidence intervals (CI) using random-effects models. Funnel plots and Egger's regression test were used to assess publication bias. Twenty-four RCTs were reviewed and 20 were included in the meta-analysis. A total of 4344 participants were included (n = 2197 in the intervention group and n = 2147 in the control group), and the intervention durations ranged from 6weeks to 3.6years. Ezetimibe coadministered with statin therapy, compared with control treatment, significantly reduced low-density lipoprotein cholesterol (LDL-C; n = 20 studies) [WMD - 0.39mmol/L, 95% CI - 0.73 to - 0.05; p < 0.001], triglycerides (TG; n = 18 studies) [WMD - 0.23mmol/L, 95% CI - 0.33 to - 0.13; p < 0.001], and total cholesterol (TC; n = 17 studies) [WMD - 0.31mmol/L, 95% CI - 0.45 to - 0.17; p < 0.001). Although the effect of statin/ezetimibe combinations on high-density lipoprotein cholesterol (HDL-C; n = 17 studies) [WMD 0.02mmol/L, 95% CI - 0.05 to 0.09; p < 0.001) was very minimal and no effect was observed on HsCRP levels (n = 11 studies). Our study found that statin/ezetimibe combinations reduced LDL-C, TC, and TG levels but had minimal effects on HDL-C and no effect HsCRP biomarkers in ASCVD patients. The statin/ezetimibe therapy enabled a more effective reduction in LDL-C levels; however, the duration of the treatment was suboptimal.

Characteristics of Japanese elderly patients with pulmonary arterial hypertension

Previous nationwide Japanese data suggested that pulmonary arterial hypertension (PAH) predominantly affects young women. However, the number of elderly patients diagnosed with PAH has been increasing in western countries. There have been no reports on elderly PAH patients in Asian countries. This study aimed to investigate the clinical characteristics of elderly PAH patients in a Japanese cohort. Idiopathic/heritable PAH (I/H-PAH) was included in the national research project on intractable diseases. The patients were required to submit a clinical research form completed by their attending physicians. We analyzed the characteristics of Japanese I/H-PAH using the newly registered forms in 2013 (Study 1, n = 148). Also, we did a retrospective, observational cohort study at Chiba University Hospital (Study 2, n = 42). We compared the characteristics of elderly PAH patients (≥65 years old) with younger patients (<65) in both studies. Study 1 revealed a predominance of males (51% male), better hemodynamics and poorer exercise capacity in the elderly group (n = 72), compared with the younger group (n = 76) in study 1. In Study 2, elderly patients showed a male predominance (63% male), a higher ratio of smokers, a lower % carbon monoxide diffusing capacity, and poorer exercise tolerance. Elderly patients in Study 2 showed less improvement in hemodynamics with therapy. There was no significant difference in disease-specific survival between elderly and younger patients. Japanese elderly patients with I/H-PAH showed poorer exercise capacity and impaired gas exchange, but better pulmonary hemodynamics than younger patients.