Risk Factors For High Incidence Research Articles

Examining the Association between Medical Marijuana Legalization and Criminal Behaviors: Evidence from a U.S. Representative Sample

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015–2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015–2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted.

Risk factors and prognosis for latent tuberculosis infection in dialysis patients: A retrospective cohort study at a single tertiary care center.

Recent studies report that latent tuberculosis infection (LTBI) may lead to an increased risk of cardiovascular disease (CVD) that led us to hypothesize that LTBI may play an important role in major adverse cardiovascular events (MACE) in dialysis patients. A single-center retrospective cohort study was conducted. A total of 270 patients undergoing hemodialysis or peritoneal dialysis more than 3 months were included. The interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay was used for the diagnosis of LTBI. Primary endpoints were MACE, including all-cause death and acute coronary syndrome (ACS). The association between LTBI and MACE was examined using multivariate Cox proportional hazards regression after adjusting for covariates and Kaplan-Meier survival analysis. In our study, the patients were classified into LTBI (n =47) or non-LTBI (n =223) groups. Independent risk factors for LTBI in dialysis population were prior tuberculosis (TB) history (odds ratio [OR] 4.817 [1.064-22.306]), tobacco use (OR 2.903 [1.155-7.299]), and older age (OR 1.027 [1.002-1.053]). After a median follow-up of 39 months, the incidence of active TB was 6.4% versus 0% in dialysis patients with and without LTBI, respectively (p = 0.005). Multivariate Cox analysis showed that LTBI was significantly associated with MACE (hazardratio[HR] 2.540 [1.490-4.350]) after adjustment for potential confounders. Prior TB history, tobacco use, and the elderly can be used to select cost-effective LTBI screening target groups in dialysis patients. LTBI is not only closely related to active TB but also an independent risk factor for higher incidence of MACE in dialysis population.

International cross-sectional survey on endoscopic retrograde cholangiopancreatography training by the World Endoscopy Organization.

Endoscopic retrograde cholangiopancreatography (ERCP) has revolutionized the treatment of many pancreaticobiliary conditions. However, little is known about the global practices, training programs, and credentialing of the procedure. The aim of the current study is to address the above questions. This was an international cross-sectional survey conducted between October 2020 and May 2021. Participating countries were requested to complete an online survey on ERCP services and training. Eighty-nine countries responded to the survey. There were significant increases in the proportion of ERCP services provided by the government (P < 0.0001), number of endoscopists per million of population (P < 0.0001), and number of institutions per million of population (P < 0.0001) from low to high human development index (HDI). Eighteen percent of the countries offer the procedure as part of a standard training program, 68.5% do not follow a standardized training curriculum. Risk factors for higher incidence and mortality from pancreatic cancers include higher HDI category, smaller population, a larger number of endoscopists proficient in ERCP, and lower number of institutions providing ERCP training. Countries with very high HDI have four times higher incidence and mortality from pancreatic cancers as compared to those with low HDI. There is still an ongoing need for improving ERCP training in low to very high HDI countries. A structured training program is still lacking in many parts of the world. With increasing incidence and mortality of pancreatic cancers, particularly in high HDI countries, there is a need for further increasing facilities for ERCP training.

MO548: Endothelial Cell Derived Exosomes Promote Vascular Smooth Muscle Cell Calcification and Senescence by Regulating the Β-Catenin Signaling Pathway Through miRNA-29B-3p

Abstract BACKGROUND AND AIMS Vascular calcification is an important risk factor for high incidence of cardiovascular events and death in patients with chronic kidney disease (CKD). The mechanism of how the calcification signal in early CKD is transmitted to vascular smooth muscle cells (VSMCs) from endothelial cells in the tunica intima to initiate the whole process of vascular calcification remains to be elucidated. The aim of this study was to investigate the effect of miRNA-29B-3p in exosomes derived from vascular endothelial cells under high phosphorus stimulation on VSMC calcification and senescence. METHOD Firstly, human umbilical vein endothelial cells (HUVECs) were divided into the high-phosphorus group (HP-HUVEC, 3mmol/L) and the control group (NP-HUVEC) for exosomes isolation by superspeed centrifugation. Transmission electron microscopy, molecular size analysis and Western blot analysis of exosome markers were used to identify exosomes. Secondly, VSMCs were treated with HP-HUVEC-Exo, NP-HUVEC-Exo and blank control. Then, HUVECs were transfection with miR-29b-3p mimic, miR-29b-3p inhibitor and their controls for the extraction of exosomes. VSMCs were further treated with Exo-miR-29b-3p mimic, Exo-miR-29b-3p inhibitor and their controls. Western Blot was used to detect the expressions of calcification-related protein Runx2, senescence-related protein P21 and β-catenin pathway-related proteins (GSK-3β and β-catenin). Alizarin red staining, ALP activity detection and calcium (Ca) content determination were used to detect the calcification of VSMC. The senescence of VSMC was detected by SA-β-gal staining and the expression of miR-29b-3p was detected by qRT-PCR. RESULTS The expression of marker proteins CD9 and CD63 was observed by Western Blot, the diameter of particle size analysis was about 172.3 ± 72.5 nm and the structure of typical lipid double-layer membrane was observed, suggesting that exosomes were extracted. Compared with the NP-HUVEC-Exo and blank control group, Western Blot showed that the expression of Runx2, P21 and β-catenin was up-regulated and the expression of GSK-3β was down-regulated in VSMC treated with HP-HUVEC-Exo. VSMC treated with HP-HUVEC-Exo also showed up-regulated miR-29b-3p expression, higher ALP activity and Ca content, suggesting exosomes from high phosphorus-stimulated endothelial cells induced calcification and senescence of VSMCs. Compared with the control group, the expression of Runx2 and P21 was up-regulated and showed more significant calcification and aging characteristics and the expression of GSK-3β was down-regulated and the expression of β-catenin was up-regulated in VSMC treated with Exo-miR-29b-3p mimic. VSMC treated with Exo-miR-29b-3p inhibitor showed the opposite results, indicating that miR-29b-3p could repress GSK-3β and activate β-catenin pathway to promoted VSMC calcification/senescence. CONCLUSION Exosomes produced from high phosphorus stimulates endothelial cells could induce the calcification and senescence of VSMC by conveying miR-29b-3p to VSMC and then regulating the β-catenin signaling pathway.

Gestational diabetes and intraoperative tubal sterilization are risk factors for high incidence of pain after cesarean delivery: a prospective observational study.

Postcesarean delivery pain leads to several adverse maternal outcomes. The primary objective of this study was to determine the incidence of moderate-to-severe pain after the use of spinal morphine for cesarean delivery. The secondary aim was to identify factors influencing moderate-to-severe pain. This was a prospective observational study. The inclusion criteria were a patient age of ≥18 years, and undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine (200 mcg). Moderate-to-severe pain was defined as a numerical rating scale score of more than 3. Preoperative and intraoperative data were collected including parity, history of cesarean delivery, pregnancy-associated problem, anesthesia blockade level, level of surgeon experience, incision type, tubal sterilization or appendectomy, and peritoneum suture. Chi-squared or Fisher's exact tests were used to examine risk factors. Multiple logistic regression was used to analyze independent factors associated with moderate to severe pain. In all, 660 patients were enrolled. As 16 were subsequently removed because they met the study withdrawal criteria, data relating to 644 patients were analyzed. The incidence of moderate-to-severe pain during the first postoperative day was 451/644 patients [70.03%; 95% confidence interval (CI): 66.38-73.44%]. The median pain score [interquartile range (IQR)] was 5 (3-6), with 176/644 (27.33%) patients needing rescue analgesics. A multivariate analysis revealed that two factors were associated with moderate-to-severe pain on the first postoperative day: gestational diabetes [adjusted OR (AOR), 1.849; 95% CI: 1.068-3.203; P=0.028] and intraoperative tubal sterilization (AOR, 1.533; 95% CI: 1.060-2.218; P=0.023). A significantly higher number of patients experienced moderate-to-severe pain on postoperative Day 1 [451/644 (70.03%)] than on Day 2 [349/644 (54.19%); P<0.001]. The median pain score [IQR] on postoperative Day 2 was 4 [3-5], which was less than on Day 1 (P<0.001). A high incidence of moderate-to-severe postoperative pain was found after a single dose of spinal morphine for cesarean delivery. Adequate pain control is required in women at risk of postcesarean delivery pain. More studies are needed on the analgesic requirements of diabetic patients or patients who receive intraoperative tubal sterilization.

Streptococcus dysgalactiae ssp. dysgalactiae in Norwegian bovine dairy herds: Risk factors, sources, and genomic diversity

Despite the importance of Streptococcus dysgalactiae ssp. dysgalactiae (SDSD) as an udder pathogen, the reservoir and epidemiological characteristics of this bacterium are largely unexplored. The aims of this study were to investigate risk factors for SDSD intramammary infections (SDSD-IMI) in Norwegian bovine dairy herds, identify sources of SDSD on animals and in the environment, and elucidate the genetic diversity of SDSD isolates. Data from herd recordings and a questionnaire were used to investigate herd-level risk factors for SDSD-IMI in 359 freestall dairy herds. Seven herds with a suspected high prevalence of SDSD-IMI were visited to sample extramammary sources (e.g., skin, wounds, mucous membranes, and freestall environment). Bacterial isolates were whole-genome sequenced to investigate the distribution of SDSD genotypes within herds and to assess the phylogenetic relationship between SDSD isolates from 27 herds across Norway. Risk factors for high incidence of SDSD-IMI in freestall dairy herds were related to housing, including closed flooring in alleys and rubber mats in cubicle bases. Parlor milking was also a risk factor compared with automatic milking systems. From herd visits, a considerable proportion of extramammary samples were SDSD positive, particularly from wounds and skin of the animals and the cubicle bases. Samples from mucous surfaces (nostrils, rectum, and vagina) and water troughs were least frequently positive. Eight multilocus sequence types (ST) were identified among the sequenced isolates from 27 herds, and phylogenetic analyses revealed 8 clades corresponding to ST. No significant association was identified between sampling site (milk, body sites, and environment) and ST. In 4 of 6 herds from which 5 or more isolates were available, one ST dominated and was found in milk and extramammary samples. One ST (ST453) was found in 15 of 27 herds, which implies that this is a widely distributed and possibly a bovine-adapted strain. Findings in this study suggest that SDSD is a cow-adapted opportunist with potential for contagious transmission, and that the freestall environment is likely to play a role in transmission between cows.

Virulence Genes and Antimicrobial Resistance Profile of Escherichia Coli Isolates from Diarrhoeic Neonatal Dromedary Camels

In the present study, Escherichia coli were isolated from rectal swabs of total 48 (20.68%) diarrhoeic neonatal dromedary camels during the five years study period in an organised farm. The PCR for amplification of virulence genes revealed that 31 (64.58%) isolates harboured at least one virulence gene. The detection rates of stx1, stx2, eae, F41, K99 and sta virulence genes were 4.16%, 2.08%, 35.41%, 14.58%, 18.75% and 16.66%, respectively. Based on occurrence of these virulence genes the isolates were pathotyped into shigatoxigenic E. coli (STEC) (6.25%), enteropathogenic E. coli (EPEC) (20.83%) and enterotoxigenic E. coli (ETEC) (29.16%). Atypical combinations of EPEC+ETEC (8.33%) were also detected. The E. coli isolates from all three neonatal camels having acute haemorrhagic enteritis and mortality were found to be of STEC type. In antibiotic sensitivity test, most prevalent resistance was observed against amoxicillin, cloxacillin, erythromycin and lincomycin whereas lowest resistance was observed against gentamicin and amikacin. Findings of this study indicate that neonatal camels are the probable reservoir of multidrug resistant and zoonotic STEC. Young age (below 7 days), housing system with loose sandy ground and winter season were identified as important risk factors for high incidence of neonatal camel calf diarrhoea in the present study.

Incidence of nontuberculous mycobacterial disease and coinfection with tuberculosis in a tuberculosis-endemic region: A population-based retrospective cohort study.

Nontuberculous mycobacteria (NTM) infection may interfere in the diagnosis and treatment of tuberculosis (TB) in TB-endemic regions. However, the population-based incidence of NTM disease and NTM–TB coinfection remains unclear.We used Taiwan's National Health Insurance Research Database to identify new diagnoses of NTM disease and TB from 2005 to 2013 and calculated the incidence rate and the proportion of NTM–TB coinfection. The patients with NTM disease or TB were determined by the use of disease codes from International Classification of Diseases, Ninth Revision, Clinical Modification, laboratory mycobacterium examination codes, and antimycobacterial therapy receipts.From 2005 to 2013, the age-adjusted incidence rate of NTM disease increased from 5.3 to 14.8 per 100,000 people per year and the age-adjusted incidence rate of NTM–TB coinfection was around 1.2 to 2.2 per 100,000 people per year. The proportion of NTM–TB coinfection among patients with confirmed TB was 2.8%. Male and older patients had a significantly higher incidence of NTM disease. The effects of urbanization and socioeconomic status (SES) on the incidences of TB and NTM disease were different. Rural living and lower SES were significantly associated with increasing the incidence of confirmed TB but not with that of NTM disease. For NTM disease, those living in the least urbanized area had significantly lower incidence rate ratio than in the highest urbanized area. The incidence of NTM–TB coinfection was higher in older patients and compared with patients aged < 45 years, the incidence rate ratio of the patients aged> 74 years was 12.5.In TB-endemic Taiwan, the incidence of NTM disease increased from 2005 to 2013. Male gender and old age were risk factors for high incidence of NTM disease. SES did not have a significant effect on the incidence of NTM disease, but rural living was associated with lower incidence of NTM disease. In TB-endemic areas, NTM–TB coinfection could disturb the diagnosis of TB and treatment, especially in elderly patients.

Progress in research on venous thromboembolism in elderly patients with lung cancer

Venous thromboembolism(VTE)is one of the common and serious complications of malignant tumors.In elderly lung cancer patients, problems such as decreased autonomic activity, bed rest, poor performance status(PS), combined underlying diseases and the use of chemoradiotherapy are often considered as risk factors for high incidence of VTE.This article is aimed to review the clinical features and pathogenesis of lung cancer in the elderly combined with VTE, to investigate the risk factors and explore feasible evaluation and prevention strategies. Key words: Lung neoplasms; Venous thromboembolism; Risk factors

Study of modifiable risk factors for instituting evidence-based preventive strategy for carcinoma esophagus in Punjab: A study protocol

Background: In Punjab, esophageal carcinoma has been reported as leading cancer in rural population. Reason for this high incidence of esophageal carcinoma in this region is unknown. The life style of people in Punjab is different from those of other areas in India. Therefore, the risk factors contributing to esophageal carcinoma in Punjab may also be different than the other parts of India. There are no previous studies on risk factors for high incidence of esophageal carcinoma in this region. Use of pesticides is much higher in Punjab state. Also there is no evidence available for association of use of pesticides/fumigants in occurrence of esophageal carcinoma. Hence this study is planned to identify the risk factors, especially the role of chemical toxicity (Pesticides/fumigants/heavy metals) associated with development of esophageal carcinoma among inhibitants of Punjab. Methods: A case-control design will be used to identify potential risk factors associated with development of carcinoma esophagus in Punjab. Cases will be recruited from PGIMER, Chandigarh, Population based cancer registry Mansa, Sangrur, SAS Nagar and Punjab Cancer control cell. For each esophageal cancer case 2 controls will be selected after matching for gender, age and area of residence. A pre designed questionnaire, including demographic characteristics, family cancer history, personal medical history, height, weight, life-style (habits such as smoking, tobacco chewing, alcohol drinking, etc.), dietary habits, fumigants and pesticide usage and practices etc, will be used. Urine samples will be taken for the analysis of pesticide metabolites. Heavy metals analysis will be done in water samples. Oral health will be examined for mucosal changes as well as for oral hygiene. Discussion: This study will results in identification of risk factors for high occurrence of esophagus carcinoma in Punjab, so that measures for early detection, prevention and control of esophagus carcinoma could be initiated.

Incidence and Risk Factors for Venous Thromboembolism Following Hip Arthroscopy: A Population-Based Study

To determine the incidence of symptomatic venous thromboembolism (VTE) after hip arthroscopy (HA) using a large national database while considering several patient demographic factors. Patients ≥20years old who underwent HA between 2007 and 2017 were identified within the Humana administrative claims database using relevant Current Procedural Terminology and International Classification of Diseases Ninth and Tenth Revision codes. Basic demographics, including age, gender, obesity (body mass index ≥ 30kg/m2), oral contraceptive use, smoking history, diabetes, and chronic obstructive pulmonary disease (CLD) were recorded. Postoperative incidence of deep vein thrombosis, pulmonary embolism, and VTE was identified at 30 and 90days postoperatively. Multivariate logistic regression analysis was performed to identify independent risk factors for VTE after HA, with statistical significance set at P < .05. Overall, 9,477 patients underwent HA procedures over the study period, of whom 5,085 (53.7%) were female. The overall incidence of VTE in all patients was 0.77% (n= 73) and 1.14% (n= 108) at 30 and 90days, respectively. Multivariate analysis identified age ≥ 45 (odds ratio [OR]= 1.82; 95% confidence interval [CI], 1.36-2.49; P= .0001), obesity (OR= 1.54; 95% CI, 1.27-1.86; P < .0001), smoking (OR= 1.26; 95% CI, 1.04-1.53; P= .0177), diabetes (OR= 1.59; 95% CI, 1.32-1.92; P < .0001), and CLD (OR= 2.10; 95% CI, 1.63-2.68; P < .0001) as independent risk factors for higher incidence of VTE after HA. However, neither gender nor oral contraceptive use were risk factors for VTE after HA. For patients undergoing HA, the incidence of symptomatic postoperative VTE is low. This study identified age ≥45, obesity, tobacco use, diabetes, and CLD as independent risk factors for VTE after HA. Level III, retrospective cohort study.

Rational control of arterial pressure during labor in women with arterial hypertension.

Were to identify the advantages and disadvantages of different protocols of antihypertensive therapy in women with arterial hypertension during the process of labour and their effects on the labour progressing and perinatal complications. 228 women who had childbirth in 2013-2018 in the Ternopil perinatal centre "Mother and Child" were surveyed. The study included full-term singleton pregnancies in cephalic presentation. According to the treatment program, women were divided into 4 groups: Group 1: 58 pregnant women who neglected treatment or had insufficient compliance; Group 2: 57 pregnant women who used methyldopa and classic beta-blockers during pregnancy and labor; Group 3: 57 pregnant women who received high selective beta-blocker with vasodilating properties nebivolol in addition to methyldopa; Group 4: 56 healthy pregnant women with normal blood pressure and without other somatic pathology. Hypertension and inadequate hemodynamic control can become risk factors for higher incidence of low birth weight, prolonged or discoordinated labour, excessive blood loss during and after delivery. The program of treating hyper- tension in pregnant women with nebivolol hydrochloride provides sufficient control of blood pressure and helps to avoid blood pressure spikes or an excessive increase of systolic and diastolic blood pressure and heart rate during childbirth, which could endanger the mother's health. The treatment with nebivolol hydrochloride for women with chronic arterial hypertension during pregnancy and delivery allows to normalize the progress and duration of labour, decrease the incidence of low birth weight and the percentage of excessive blood loss during labour.

Smokeless Tobacco: An Etiological Risk Factor for High Incidence of Pyriform Sinus Cancer in Assam, India

Background: Cancer incidence in northeast India including Assam state is higher than the Indian national average. The incidence of hypopharyngeal cancer mainly pyriform sinus is high in (14.7/100,000) Assam and other northeastern state like Meghalaya (East Khasi Hills). Recently published Global Adult Tobacco Survey (GATS 2) report has shown that there is a decrease in tobacco consumption in India from 34.6% to 28.6%. However, in Assam the rate has increased from 39.3% to 48.2% mainly in the form of smokeless tobacco. Cigarette smoker reduce from 8.8% (GATS 1, 2009-10) to 6.1% (GATS 2, 2017), but smokeless users increase from 32.7% (GATS 1, 2009-10) to 41.7% (GATS 2, 2017). By now in India we only have gutka and pan masala (Prohibition) act 2015, by which there is ban on gutka but not other smokeless tobacco product. Because of COTPA (Cigarettes-and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, there is reduction of smoking in India as well as in the state of Assam. But as we don't have stringent laws to control the use of smokeless tobacco, the users are increasing. Aim: To study the role of smokeless tobacco as a substantial etiological risk factor for high incidence of pyriform sinus cancer in Assam and to advocate for a strict law to prohibit or ban of smokeless tobacco in Assam. Methods: This is a retrospective study archived from hospital cancer registry database. 708 patients diagnosed with pyriform sinus carcinoma from January 2016 to December 2016 were analyzed. The relation between forms of tobacco use and gender, age group, place of residence and level of education were analyzed using IBM SPSS version 19. P &lt; 0.05 was considered as statistically significant. Results: 584 (82.5%) patients had the habit of tobacco consumption of whom 128 (21.9%) were smokers, 220 (37.6%) consumed smokeless tobacco and the remaining 237 (40.5%) cases consumed both forms of tobacco products. Forms of tobacco use differ significantly with patient's gender ( P &lt; 0.05). The patients in the age group ≥ 50 years or above 50 years, the highest frequency was observed in both forms of tobacco consumption (61/144 = 42.4% and 176/441 = 39.9%) respectively. Most of the patients from rural areas were habituated to both forms of tobacco use (201/499 = 40.3%) and most of them are mainly smokeless tobacco user. Conclusion: The current study shows that the incidence of smokeless tobacco user is alarmingly increasing in Assam and the northeastern part of India leading to high incidence of hypopharyngeal cancers. At present only gutka is banned in the India. So, further policies should be implemented to bring down the use of smokeless tobacco and thus reducing the burden of hypopharyngeal cancer in this part of the country.

Estimating the carbohydrate content of various forms of tobacco by phenol-sulfuric acid method.

BACKGROUND:Due to consumption of various forms of tobacco in large amounts by Indian population, it has become a cause of concern for major oral diseases. In 2008, the WHO named tobacco as the world's single greatest cause of preventable death. It is also known that certain amount of carbohydrates are incorporated in processed tobacco to make it acceptable for consumption. Thus, its role in oral diseases becomes an important question at this point of time. Through this study, it is attempted to find out the carbohydrate content of various forms of tobacco by phenol-sulfuric acid method.MATERIALS AND METHODS:Tobacco products selected for the study were Nandi hookah tambakhu (A), photo brand budhaa Punjabi snuff (B), Miraj (C), Gai-chhap tambakhu (D), Hanuman-chhap Pandharpuri tambakhu (E), and Hathi-chhap Bidi (F). The samples were decoded and transported to laboratory and tested at various concentrations by phenol-sulfuric acid method followed by ultraviolet spectrophotometry to determine their absorbance.RESULTS:The present study showed Hathi-chhap bidi/sample F had a maximum absorbance (1.995) at 10 μg/ml which is a smoking form of tobacco followed by rest all smokeless forms of tobacco, i.e. sample C (0.452), sample B (0.253), sample D (0.077), sample E (−0.018), and sample A (−0.127), respectively.CONCLUSION:As the concentration of tobacco sample increases, their absorbance increases which in turn is suggestive of increase in its carbohydrate concentration. Carbohydrates in the form of sugars, either inherently present or added in it during manufacturing can serve as a risk factor for higher incidence of dental caries.

An analysis of risk factors for brain metastases after prophylactic cranial irradiation for limited-stage small-cell lung cancer

Objective To evaluate the high-risk factors for brain metastases after prophylactic cranial irradiation (PCI), and to provide a basis for personalized treatment. Methods A retrospective analysis was performed in 188 patients with limited-stage small-cell lung cancer who received PCI in our hospital from 2005 to 2010. The Kaplan-Meier method was used to calculate the cumulative rate of brain metastases. The log-rank test and the Cox model were used for the univariate and multivariate analyses of the potential factors for the cumulative incidence of brain metastases, respectively. Results In the 188 patients, 31(16.5%) had brain metastases. The 1-, 2-, and 3-year cumulative incidence rates of brain metastases were 4%, 15%, and 20%, respectively. The univariate analysis showed that staged Ⅲ disease before treatment, elevated levels of tumor markers, incomplete remission after chemoradiotherapy, and local-regional relapse were risk factors for high incidence of brain metastases (P=0.044, 0.037, 0.005, 0.007). The multivariate analysis revealed that incomplete remission after chemoradiotherapy and local-regional relapse after chemoradiotherapy were risk factors for high incidence of brain metastases after PCI (P=0.003, 0.040). Conclusions Patients with incomplete remission or local-regional relapse after chemoradiotherapy have high incidence of brain metastases after PCI. For those patients, a frequent follow-up of the central nervous system plus salvage cranial irradiation might provide an alternative to PCI. Key words: Small cell carcinoma, lung/prophylactic cranial irradiation; Brain metastasis; Risk factor

Drinking water: a risk factor for high incidence of esophageal cancer in Anyang, China.

Anyang is known to be a high-incidence area of esophageal cancer (EC) in China. Among a long list of risk factors, the quality of drinking water was evaluated. We have selected 3806 individuals and collected 550 drinking water samples correspondent with this not-matched case-control survey. There are 531 EC patients included based on Population Cancer Registry from 92 townships, of which 3275 controls with long-lived aged over 90years and free from EC are used as controls in the same regions. Our result suggests that the quality of drinking water is a highly associated risk factor for EC. The residential ecological environment and the quality of water resource positively link with each other. The analysis of water samples also demonstrated that the concentrations of methyl ethylamine, morpholine, N-methylbenzylamine, nitrate and chloride in water from springs and rivers are higher than those in well and tap water (P=0.001). Micronuclei formation tests show that well water and tap water in these regions have no mutagenicity.

Genetic Polymorphism of Glutathione S-transferases M1 and T1, Tobacco Habits and Risk of Stomach Cancer in Mizoram, India

The incidence of stomach cancer in Mizoram is highest in India. We have conducted a population based matched case-control study to identify environmental and genetic risk factors in this geographical area. A total of 102 histologically confirmed stomach cancer cases and 204 matched healthy population controls were recruited. GSTM1 and GSTT1 genotypes were determined by PCR and H. pylori infections were determined by ELISA. Tobacco-smoking was found to be an important risk factor for high incidence of stomach cancer in Mizoram. Meiziol (local cigarette) smoking was a more important risk factor than other tobacco related habits. Cigarette, tuibur (tobacco smoke infused water) and betel nut consumption synergistically increased the risk of stomach cancer. Polymorphisms of GSTM1 and GSTT1 genes were not found to be directly associated with stomach cancer in Mizoram. However, they appeared to be effect modifiers. Persons habituated with tobacco smoking and/or tuibur habit had increased risk of stomach cancer if they carried the GSTM1 null genotype and GSTT1 non-null genotype. Tobacco smoking, especially meiziol is the important risk factor for stomach cancer in Mizoram. GSTM1 and GSTT1 genes modify the effect of tobacco habits. This study is a first step in understanding the epidemiology of stomach cancer in Mizoram, India.

Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device

Postoperative development of aortic insufficiency (AI) after implantation of left ventricular assist devices (LVADs) has recently been recognized, but the devices in the previous reports have been limited to the HeartMate I or II. The purposes of this study were to determine whether AI develops with other types of LVADs and to elucidate the factors associated with the development of AI. Thirty-seven patients receiving LVADs without evident abnormalities in native aortic valves were enrolled (pulsatile flow LVAD [TOYOBO]: 76%, continuous flow LVAD [EVAHEART, DuraHeart, Jarvik2000, HeartMate II]: 24%). Frequency of aortic valve opening and grade of AI were evaluated by the most recent echocardiography during LVAD support. None of the patients had more than trace AI preoperatively. During LVAD support AI >- grade 2 developed in 9 patients (24%) across all 5 types of devices. More severe grade of AI correlated with higher plasma B-type natriuretic peptide concentration (r = 0.53, P < 0.01) and with less frequent of the aortic valve (r = 0.45, P < 0.01). Multivariate analysis revealed that lower preoperative left ventricular ejection fraction and a continuous flow device type were independent risk factors for higher incidence of AI. AI, which is hemodynamically significant, develops after implantation of various types of LVADs. Physicians need to be more alert to the development of AI particularly with continuous flow devices.

Pathogenesis of vascular calcification in chronic kidney disease

Pathogenesis of vascular calcification in chronic kidney disease. Background. Hyperphosphatemia and hypercalcemia are independent risk factors for higher incidence of cardiovascular events in patients with chronic kidney disease. In addition to increased calcium-phosphate product, hyperphosphatemia accelerates the progression of secondary hyperparathyroidism with the concomitant bone loss, possibly linked to vascular calcium-phosphate precipitation. Results. The control of serum phosphate levels reduces vascular calcification not only by decreasing the degree of secondary hyperparathyroidism and calcium-phosphate product, but also by reducing the expression of proteins responsible for active bone mineral deposition in cells of the vasculature. The calcium and aluminum-free phosphate-binders provide a new and effective therapeutic tool in preventing vascular calcifications in chronic kidney disease in animal models and in hemodialysis patients. Conclusion. Additional investigations are necessary to examine the benefits of different phosphate-binders in reducing mortality from cardiovascular disease.

Incidence and risk factors of upper extremity deep vein lesions after permanent transvenous pacemaker implant: a 6-month follow-up prospective study.

The incidence of venous lesions after permanent pacemaker insertion is around 45%. However, this incidence has been based on retrospective studies in a small series; moreover, factors predicting the development of these venous injuries have not been clearly defined. The aim of this study was to identify the risk factors for higher incidence of upper extremity deep vein thrombosis after transvenous permanent pacemaker insertion. The study included 229 patients and the criteria were age above 12 years and first permanent transvenous pacemaker implant. Exclusion criteria were pulmonary embolism, lower or upper extremity deep venous thrombosis, previous use of central venous catheters, coagulation disturbances, and malignancy. Age, race, sex, underlying cardiac disease, functional class to heart failure, LVEF, venous access, number, material and caliber of the leads, and previous use of a transvenous temporary pacemaker were considered. Six months after the pacemaker was implanted, 202 patients were submitted to digital subtraction venography ipsilateral to pacemaker implant. The venographies were normal in 73 (36%) patients and abnormal in 129 (64%) patients. Patients with previous use of transvenous temporary leads (P = 0,0001, OR = 4,260, confidence limits = 2,133-8,465) and LVEF < or = 40% (P = 0,0378, OR = 3,437, confidence limits = 1,064-12,326), had higher incidence of venous lesions. Previous use of a temporary pacemaker and LVEF < or = 0.40 were considered independent risk factors to a higher incidence of venous stenosis or thrombosis 6 months after permanent pacemaker insertion.