Unspecified Origin Research Articles

EpCAM-CD24+ circulating cells associated with poor prognosis in breast cancer patients

Following the discovery of circulating tumor cells (CTCs) in the peripheral blood of cancer patients, CTCs were initially postulated to hold promise as a valuable prognostic tool through liquid biopsy. However, a decade and a half of accumulated data have revealed significant complexities in the investigation of CTCs. A challenging aspect lies in the reduced expression or complete loss of key epithelial markers during the epithelial-mesenchymal transition (EMT). This likely hampers the identification of a pathogenetically significant subset of CTCs. Nevertheless, there is a growing body of evidence regarding the prognostic value of such molecules as CD24 expressing in the primary breast tumor. Herewith, the exact relevance of CD24 expression on CTCs remains unclear. We used two epithelial markers (EpCAM and cytokeratin 7/8) to assess the count of CTCs in 57 breast cancer patients, both with (M0mts) and without metastasis (M0) during the follow-up period, as well as in M1 breast cancer patients. However, the investigation of these epithelial markers proved ineffective in identifying cell population expressing different combinations of EpCAM and cytokeratin 7/8 with prognostic significance for breast cancer metastases. Surprisingly, we found CD24+ circulating cells (CCs) in peripheral blood of breast cancer patients which have no epithelial markers (EpCAM and cytokeratin 7/8) but was strongly associated with distant metastasis. Namely, the count of CD45-EpCAM-CK7/8-CD24+ N-cadherin—CCs was elevated in both groups of patients, those with existing metastasis and those who developed metastases during the follow-up period. Simultaneously, an elevation in these cell counts beyond the established threshold of 218.3 cells per 1 mL of blood in patients prior to any treatment predicted a 12-fold risk of metastases, along with a threefold decrease in distant metastasis-free survival over a 90-month follow-up period. The origin of CD45-EpCAM-CK7/8-CD24+ N-cadherin—CCs remains unclear. In our opinion their existence can be explained by two most probable hypotheses. These cells could exhibit a terminal EMT phenotype, or it might be immature cells originating from the bone marrow. Nonetheless, if this hypothesis holds true, it's worth noting that the mentioned CCs do not align with any of the recognized stages of monocyte or neutrophil maturation, primarily due to the presence of CD45 expression in the myeloid cells. The results suggest the presence in the peripheral blood of patients with metastasis (both during the follow-up period and prior to inclusion in the study) of a cell population with a currently unspecified origin, possibly arising from both myeloid and tumor sources, as confirmed by the presence of aneuploidy.

A rare case of bleeding in diverticular disease of the small intestine

The article describes a clinical case of bleeding from diverticula of the small intestine in patient E. 1957, who entered the State Budgetary Institution RO OKB on 10/03/2023. with clinical picture gastrointestinal bleeding of unspecified etiology. In the result of a diagnostic study, collection of anamnestic data and clinical picture, a diagnosis was made: gastrointestinal intestinal bleeding of unspecified origin. After FGDS and no visible sources of gastric bleeding, and lack of positive effect from conservative therapy, increasing hypotension, deterioration of general condition with hemoglobin 82 g/l. a decision was made to perform a blood transfusion and combined hemostatic therapy. Conservative treatment turned out to be ineffective, and therefore it was accepted decision on emergency surgical treatment. Urgent patient a diagnostic laparotomy was performed. During revision of the abdominal organs cavity, the source of bleeding was identified. A section of the small intestine was resected at a distance of 15 cm from the ligament of Treitz over a distance of 70 cm with multiple diverticula. An interintestinal side to side anastomosis. In the postoperative period, data for relapse. There is no gastrointestinal bleeding. On day 9 the patient was discharged under the supervision of a surgeon at the place of residence in satisfactory condition.

Associations between cytokines and the risk of female and male infertility: A two-sample Mendelian randomization analysis

PurposeObservational studies have linked cytokines to the occurrence of female and male infertility. However, it is not clear how biomarkers of inflammation are causally related to infertility. To explore whether genetic variants in circulating cytokines are associated with the pathogenesis of infertility, we performed two-sample Mendelian randomization (MR) analysis. MethodsA total of 31,112 individuals of European ancestry were included in a genome-wide association study (GWAS) of 47 circulating cytokines as instrumental variables (IVs). Outcome data were female infertility, including four different subtypes, and male infertility, from the FinnGen consortium. Five MR methods, including inverse-variance weighted (IVW), MR-Egger, simple mode, weighted median, and weighted mode were employed to examine the genetic association between cytokines and the risk of female infertility and male infertility. The false discovery rate (FDR) was controlled using the Benjamini–Hochberg method. ResultsAfter FDR correction, cis-protein quantitative trait locus (cis-pQTL) instruments showed that the cytokines GROa and MCSF were positively associated with female infertility. In analyses of subtypes of female infertility, eotaxin and sICAM were inversely associated with ovulation-related infertility; MCP3 alone was positively associated with uterus-related infertility; GROa and MCSF were positively correlated with infertility of cervical, vaginal, and other or unspecified origin; and MIP1a was negatively correlated with tubal origin infertility. The cytokines HGF, IL-2ra, and RANTES were positively correlated with male infertility. Similar findings were obtained in sensitivity analyses. There was no evidence of pleiotropy or heterogeneity in the results. ConclusionThese findings contribute to current understanding of the role of cytokine biomarkers in the etiology of female and male infertility. Furthermore clinical experimental validation is required to evaluate the potential of these cytokines as biomarkers.

Perspective Exploring Novel Associations of IL‐18 Levels as a Mediator of the Causal Links between Major Depression and Reproductive Health

This research has suggested a link between major depressive disorder (MDD) and infertility, with interleukin‐18 (IL‐18) being proposed as a potential mediator due to its connections to both conditions. A Mendelian randomization (MR) approach was utilized in this study, which drew on genetic data from 500,199 European participants studied for MDD, along with additional IL‐18 and reproductive health data from the FinnGen consortium and GWAS datasets. Single nucleotide polymorphisms were employed as instrumental variables to examine the causal relationships between MDD, genetically predicted IL‐18 levels, and infertility. In our study, bidirectional MR analysis revealed a significant inverse causal relationship between MDD and genetically predicted IL‐18 levels, with a higher genetic predisposition to MDD, correlating with reduced IL‐18 levels (β: −0.40; 95% confidence interval (CI): −0.69 to −0.11; P = 7.09 × 10−3). Additionally, MDD is found to significantly increase the risk of female infertility. Notably, genetically predicted IL‐18 levels demonstrated a protective effect against female infertility (odds ratio (OR): 0.92; 95% CI: 0.86–0.98; P = 1.17 × 10−2). Mediation analysis indicated that genetically predicted IL‐18 levels partially mediated the impact of MDD on female infertility associated with cervical, vaginal, other or unspecified origin, accounting for up to 14.61% of this effect. No evidence of pleiotropy or heterogeneity was detected. The role of genetic predispositions to MDD in influencing genetically predicted IL‐18 levels, and subsequently, female infertility, was highlighted by our study, offering insights into the complex interplay between mental health and reproductive biology. These findings contribute to a deeper understanding of the genetic and molecular pathways influencing these conditions, suggesting new directions for research and potential therapeutic interventions.

Trends for Syndromic Surveillance of Norovirus in Emergency Department Data Based on Chief Complaints.

This study compared trends in norovirus cases to determine whether chief complaint-based emergency department (ED) visit data could reflect trends of norovirus in Korea. The ED visits from the National Emergency Department Information System database and the weekly reported number of noroviruses from the sentinel surveillance system were collected between August 2017 and December 2020. The correlation between weekly norovirus cases and weekly ED visits considering the chief complaint and discharge diagnosis code was estimated using a 3-week moving average. In total, 6 399 774 patients with chief complaints related to digestive system disease visited an ED. A higher correlation between reported norovirus cases and ED visit with chief complaint of vomiting and discharge diagnosis code of gastroenteritis and colitis of unspecified origin or other and unspecified gastroenteritis and colitis of infectious origin was observed (R = 0.88, P < .0001). The correlation was highest for the age group 0-4 years (R = 0.89, P < .0001). However, no correlation was observed between the reported norovirus cases and the number of ED visits with norovirus identified as a discharge diagnosis code. ED visit data considering a combination of chief complaints and discharged diagnosis code would be useful for early detection of infectious disease trends.

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador.

Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.

Sudden cardiac death in patients with coronary heart disease and antemortem alcohol intake: A STROBE - compliant retrospective study.

The present study was aimed to assess the prevalence and possible causal relationship of alcohol intake prior to a sudden cardiac death event in patients with coronary artery disease. The retrospective research was performed at the Vilnius branch of The State Forensic Medicine Service. The autopsy protocols for five years were analyzed and the cases of sudden cardiac death were selected, when the determined cause of death was Coronary Heart Disease (CHD), a forensic autopsy and toxicological blood and urine test had been performed. Cases of the sudden death of non-cardiac origin, cases of cardiomyopathy of various origins, and cases of acute cardiac arrest of unspecified origin were excluded. The data collected was processed using R software. The study sample consisted of 2133 cases. 706 (33%) CHD cases were alcohol positive. Males and young age CHD victims were more likely to find alcohol than females (72% vs. 28%, respectively, P < .001). The mean blood alcohol concentration of the sample was 1.37 ‰± 1.01, urine's 1.73‰ ± 1.29. Alcohol was more commonly found during the winter months and the holidays. Deaths in alcohol-positive individuals were more common in the alcohol elimination phase with hemodynamically insignificant coronary artery stenosis (up to 50% of arterial lumen). Nearly every third CHD victim in Lithuania who experienced sudden death also had signs of antemortem alcohol consumption.

Unique Pain Responses in Different Etiological Subgroups of Intellectual and Developmental Disabilities.

We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD-13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)-and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.

Phonological awareness and rapid automatized naming as predictors of early literacy skills among children with mild to borderline intellectual functioning

The aim was to investigate the predicting role of phonological awareness (PA) and rapid automatized naming (RAN) on early literacy skills (e.g., word reading [WR] and spelling [SP]) among children with mild to borderline intellectual functioning. A total of 68 children in inclusive schools in grades 1 and 2, from 12 primary schools from Makka, classified as having intellectual disabilities (ID) of unspecified origin were chosen to participate in this study. Measures of PA and RAN were correlated with measures of WR and SP in children with mild to borderline intellectual functioning. This study advanced knowledge about the predictors (PA and RAN) of early literacy skills (WR and SP) among children with mild to borderline intellectual functioning.

Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification

Introduction The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology. Aims We applied and validated EAUiaiC, for kidney tumor surgery. Patients and methods A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016–2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions. Results A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien–Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%). Conclusions The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.

Burden and pattern of acute diarrhea in Thai children under 5 years of age: a 5-year descriptive analysis based on Thailand National Health Coverage (NHC) data

BackgroundThe incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019.MethodsData regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed.ResultsThe incidence trend of yearly acute diarrhea in children 0–5 years of age slightly increased from 33.36 cases per 1,000 population in 2010 to an average of 33.79 cases per 1,000 population/ year from 2015 to 2019 or approximately 0.43 cases per 1,000 population over the last decade while diarrhea-related mortality had a low, constant rate of 0.71 to 1.16 per 100,000 population per year. Two thirds of the mortality rate was observed in children under 1 year of age or 4.1 cases per 100,000 person-years in 5-year period (P < 0.01). The high cost of performing the medical treatment of approximately four hundred million baht per year. Seasonal variations demonstrated consistency with similar patterns during the cold and rainy seasons throughout the 5-year period. Regional distribution of the causative agent was also observed in Cholera, Typhoid, and Amoebiasis cases. A08: viral and other specified intestinal infections and A09: other gastroenteritis and colitis of infectious and unspecified origin were the two most common causes of diarrheal diseases.ConclusionsThe incidence rate of acute diarrhea in Thai children under five years of age was higher while the mortality rate of acute diarrhea was lower than those in the past decade. A similar seasonal outbreak of acute diarrhea was seen during each examined year. The causative agent was not significant and was mainly unspecific.Trial registrationNumber TCTR20220117002, date of registration: 17/01/2022, site: Thai Clinical Trials Registry, URL http://www.thaiclinicaltrials.org/show/TCTR20220117002

Oral antibiotic prescription patterns for dental conditions at two public sector hospitals in Pietermaritzburg, KwaZulu-Natal

Antibiotic resistance is a growing public health concern. Yet, there is a paucity of published data in KwaZulu-Natal on antibiotic prescription trends and patterns related to dental use. The objectives of this study were to identify the range of dental conditions for which oral antibiotics are prescribed at two public health settings (Institution A and B) in the Pietermaritzburg Complex, KwaZulu-Natal and to explore practitioner understanding of the indications for antibiotic prescription for dental conditions. The study used a two-phased approach and collected a combination of qualitative and quantitative data. Phase 1 comprised a retrospective clinical chart review (n=720), while phase 2 comprised a focus-group discussion with purposively selected health care practitioners at each institution. The results of the retrospective clinical chart review indicated that dental abscesses were the most common dental infections requiring oral antibiotic therapy (n= 479; 66%), followed by acute alveolar osteitis (dry socket) (n=110; 15%), dental impactions (n=78; 11%) and dental extractions (n=62; 9%). At Institution A, antibiotic therapy was prescribed for conditions such as trismus (n=13; 6%), soft palate swelling of unspecified origin (n=9; 4%), fibrous epulis (n=6; 3%) and acute herpes simplex (n=2; 1%). Interestingly, antibiotics were not prescribed at Institution B for the same dental conditions. Antibiotic therapy was also prescribed for eruption pain (n=4; 1%) and for cases when patients did not bring their inhaler for asthma treatment (pump) (n=3; 1%). The findings from the focus-group discussions suggested that there is a need to improve practitioner understanding of the indications for antibiotic prescriptions for dental conditions. This study showed some differences in antibiotic therapy prescription patterns at the two public health institutions, especially for dental conditions that did not require such management. This suggests a need for consensus building among health professionals and the provision of more dedicated guidance for antibiotic prescription in the management of dental conditions.

Removal of an intracardiac sewing needle without inflow occlusion or cardiopulmonary bypass in a dog

AbstractA 3.5‐year‐old Australian shepherd dog referred for the exploration and management of an intrathoracic sewing needle. The animal had a history of cardiovascular collapse the previous day. On presentation, the dog was asymptomatic, bright, alert and responsive. Computed tomography scan and echocardiography confirmed the presence of a sewing needle in the heart, with moderate pericardial and bilateral pleural effusions. Using careful blind palpation of the heart after sternotomy, the sewing needle was pushed through the myocardium and retrieved without haemorrhage. Recovery was uneventful and the dog returned to full exercise. This case report describes the migration of a sewing needle into the heart from an unspecified origin, an atypical removal, and a good postoperative outcome in a 3.5‐year‐old Australian shepherd dog.

Cutaneous Manifestation of Diabetes Mellitus in an Unsheltered Male Leading to Emergent Hospitalization

Diabetes mellitus (DM) is one of the most common chronic diseases in the United States. It is characterized by increased patient morbidity and mortality due to the many complications that can arise. Certain dermatological findings can be indicative of poorly controlled DM and can be a useful clue to further management. Persons experiencing homelessness (PEH) with DM often have higher rates of diabetic complications than the general diabetic population. Medical providers caring for PEH in the setting of limited resources should carefully evaluate cutaneous disease as a potential indicator of underlying illness. This physical manifestation of illness can serve to guide the next appropriate steps in management. A 41-year-old unsheltered male with an extensive medical history of hypertension, seizures, chronic diarrhea, and cocaine use was seen at a “foot-washing” medical outreach event. He presented with fevers, chills, and multiple painless right lower extremity ulcerated lesions of unspecified origin. A finger-stick glucose measurement was found to be 650 mg/dL. After immediate administration of 10 units of insulin, he was transported immediately to the emergency department and admitted. His month-long hospital course was complicated and involved the amputation of multiple toes. Preemptive outreach and management could have prevented the marked deterioration of his disease and represents the importance of outreach and regular follow-up with the PEH community.

Congenital heart diseases, surgical treatment and complications in pediatric sample of Hospital Vicente Corral Moscoso, 2017-August 2019

BACKGROUND: The heart is the most commonly affected organ by congenital diseases, with and incidence of 0.8 per 100 newborns. Nearly two thirds of all the surgical procedures are now a days performed before the first year of life, improving survival rate and life quality. This study aims to determine the frequency of the surgical interventions performed to treat congenital heart diseases and its complications. METHODS: An observational, descriptive cross sectional study was carried out; with 70 pediatric patients diagnosed and surgically treated for congenital heart diseases. The data was collected from the patient’s medical records using a form. Statistical analysis was performed using SPSS version 15 software. RESULTS: The median age was 1.1 years, 60% of the sample were women. 90% of the heart diseases were non-cyanogenic. The most frequent diagnosis was: persistence of the arterial duct (58.57%), followed by interventricular communication (12.86%). The type of procedures corresponds to the heart disease, thus 58.57% were performed for closure of arterial duct persistence and 12.86% were surgical repairs for closure of interventricular communication. The median stay in the intensive care unit was 4 days and the median stay in general hospitalization room was 5 days. The main complications in this pediatric population undergoing a surgical procedure were: pneumonia (11.4%) and sepsis of unspecified origin (8.6%). CONCLUSION: Treatment for heart diseases were performed at early ages (average age= 2.5±3.2). More than half of the surgical procedures for congenital heart disease were performed to correct the persistence of the ductus arteriosus, the main complication was pneumonia.

Choosing patient-reported outcome measures for shoulder pathology.

This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature.A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE.506 studies were included in the final data analysis, for a total number of 36,553 patients.The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency.A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed.A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs. Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109

A survey of proteins in midgut contents of the tick, Haemaphysalis flava, by proteome and transcriptome analysis.

Tick blood meals are stored and digested in their midguts. Blood digestion is complex, and many proteins are involved. Study of the tick-derived proteins in the midgut contentmay aid in the discovery of active molecules that would be useful for anti-tick vaccines. We analyzed the midgut content proteomes of partially engorged female Haemaphysalis flava, fully engorged female H. flava, and hedgehog serum using liquid chromatography tandem-mass spectrometry and label-free quantitation. In this study, high-confidence protein profiling of tick midgut content was determined. Based on the search against our in-house transcriptome database, the 28 high-confidence proteins were identified. Of these, 17 were identified as tick-derived, and the rest were of unspecified origin (proteins that could not be differentiated as host-derived or tick-derived proteins). The function of these midgut content proteins identified here may involve nutrient transportation, anti-coagulation, erythrocyte lysis, detoxification, lipid metabolism, and immunization. The presence of hemoglobin suggested that the red blood cells were lysed in the gut lumen. The midgut contents contain a large amount of fibrinogen and it has the ability to clot immediately. The midgut contained mostly host-derived proteins,andthese host proteins provide richnutrients for tick development and reproduction. However, some intracellular proteins were also identified, suggesting the possibility of shedding of the midgut epithelium and ingestion of saliva during feeding. This finding advances our understanding of the digestive mechanism and will be useful in the screening of vaccine antigens.

Nationwide incidence of patients hospitalized for a valvular heart disease according to etiology: Patient characteristics and temporal trends in France 2006–2016

The main etiologies of valvular heart disease (VHD) are rheumatic fever and age-related degeneration. In 2016, the prevalence of patients managed for a VHD was 0,6% of the French population (341,500 people). However, few recent incidence data are available in France. Estimate the annual incidence of patients hospitalized for VHD in France according to their etiology, describe their characteristics and the temporal trends. All patients hospitalized for VHD in France between 2006 and 2016 were identified using data from the national hospital discharge database (PMSI-MCO) integrated into the national health data system (SNDS). The first stay of the year in which the patient was hospitalized with a principal or related diagnosis of VHD was selected. Descriptive analyses of patients’demographic and medical characteristics and trends from 2006–2016 were stratified according to the origin of valvular heart disease. In 2016 38,875 patients were hospitalized for a VHD in France. Of these, 89% were hospitalized for non-rheumatic VHD (52.1/100,000 person-year (PY)) with an average age of 74 years; 5% for rheumatic VHD (3.1/100,000 PY) with an average age of 67 years; 3% for congenital VHD (1.1/100,000 PY) with an average age of 29 years; and 3% for unspecified origin. The incidence of patients hospitalized for non-rheumatic VHD increased by 43% between 2006 and 2016, particularly in older patients. It has decreased by 42% for rheumatic VHD. Departmental disparities were observed for these disorders, with a high incidence of hospitalization for rheumatic VHD in the Ile-de-France, the French overseas departments and territories and the south-east. The improvement in the management of streptococcal A angina, the increase in life expectancy and the expansion of indications for the management of aortic stenosis and mitral regurgitation by transcatheter valve replacement have reshaped the distribution of types of VHD hospitalized since 2006.

A Validation Study: How Predictive Is a Diagnostic Coding Algorithm at Identifying Rheumatic Heart Disease in Western Australian Hospital Data?

International Classification of Diseases codes for rheumatic heart disease (RHD) (ICD-10 I05-I08) include valvular heart disease of unspecified origin, limiting their usefulness for estimating RHD burden. An expert opinion-based algorithm was developed to increase their accuracy for epidemiological case ascertainment. The algorithm included codes not defaulting to RHD ('probable') plus selected codes pertaining to mitral valve involvement in patients <60 years ('possible'). We aimed to determine the positive predictive value (PPV) for RHD of algorithm-selected hospital admissions. Chart reviews of RHD-coded admissions (n=368) to Western Australian tertiary hospitals (2009-2016) authenticated RHD diagnosis. We selected all cases with algorithm-positive codes from populations at high-risk of RHD and an age-stratified random sample from low-risk groups. RHD status was determined from echocardiographic reports or clinical diagnosis in charts. PPVs were compared by population risk status (high-risk/low-risk), age group, gender, principal/secondary diagnosis and probable/possible codes. High-risk patients had higher PPVs than low-risk patients (83.8% vs 54.9%, p<0.0001). PPVs were 91.5% and 51.5% respectively for algorithm-defined 'probable RHD' and 'possible' codes (p<0.0001). The PPVs in low-risk patients were higher for principal diagnoses than secondary diagnoses (84.5% vs 44.8%, weighted p<0.0001) but were similar in high-risk patients (92.5% vs 81.7%, p=0.096). The algorithm performs well for RHD coded as a principal diagnosis, 'probable' codes or in populations at high risk of RHD. Refinement is needed for identifying true RHD in low-risk groups.

Epidemiological trends of dermal sarcoma in Australia

Background: Sarcomas comprise a heterogenous group of malignant tumours of mesenchymal origin and can arise in the skin. Definitive management of skin sarcoma usually entails surgical resection with wide margins, often requiring reconstruction. The incidence and demographics of these neoplasms in Australia are poorly understood. Method: Incidence, gender and age distribution data for skin sarcomas for the period 1982–2009 were obtained from the Australian Cancer Database (ACD). Morphology and topographical region coding via the International Classification of Diseases for Oncology third edition (ICD-O-3)1 were used to identify the data.Results: A total of 5453 cases of skin sarcoma in the Australian population were identified over the 28-year period. Anatomically, 1610 cases (29%) occurred on the limbs, 1416 (26%) on the head and neck area, 957 (18%) on the trunk and 1470 (27%) had an unspecified skin origin. Overall incidence was 2.09 per 100,000 population. Males were more commonly affected (70%), most commonly in the 30–49 years and 70+ years age groups. The most common pathological subtypes were fibromatous sarcoma (including dermatofibrosarcoma protuberans), Kaposi’s sarcoma and pleomorphic dermal sarcoma.Conclusion: The Australian Cancer Database data used to describe the pattern and epidemiological trends for skin sarcoma in Australia demonstrated variation from international trends and highlight the need for further research into the aetiology of these tumours.