Trend Χ2 Research Articles

Frequent False-positive Bronchoalveolar Lavage Galactomannan Values in a Real-world Setting

BackgroundInvasive aspergillosis (IA) is the most common invasive mold infection (IMI) and early diagnosis is critical to improving clinical outcomes. Galactomannan (GM) is a major component of the Aspergillus cell wall. BAL GM is one of the mycologic criteria for diagnosis of probable IA, but it is frequently positive in patients with Aspergillus airway colonization, and its specificity has not been well-studied. Our goal was to estimate the specificity of a positive BAL galactomannan value in a contemporary cohort of consecutive patients with BAL GM checked as part of their workup for potential IA.MethodsWe reviewed clinical and microbiologic data of patients who had at least one positive BAL GM (≥0.5), at Brigham and Women’s Hospital from November 2009 to March 2016. We applied EORTC/MSG IMI definitions to classify patients as having possible, probable or proven IMI, excluding BAL GM result as mycologic criterion.ResultsWe studied 134 patients. Median age was 58; 49% were women. 54% had hematologic malignancy (HM), 10% were solid organ (SOT) and 34% hematopoetic stem-cell transplant (HSCT) recipients. 60% received mold-active antifungal treatment. 4 patients (3%) had proven, 60 (45%) probable, 15 (11%) possible, and 55 (41%) no IMI. One had proven mucormycosis, making at least 42% of positive BAL GM results falsely positive (specificity 58%, 95% confidence interval 47–69%). 6-week mortality was 35% overall: 75% for proven, 47% probable, 33% possible, and 20% for no IMI (χ2 for trend P = 0.008). In patients with no IMI, 6-week mortality was comparable in those who did not receive mold-active treatment (13%, 5/38) and those who did (38%, 6/16, Fischer’s P = 0.07).ConclusionIn this study, at least 42% of positive BAL GM values were falsely positive, potentially exposing these patients to unnecessary antifungals. The number of ‘probable’ IMI cases (which, along with proven IMI are typically included in clinical trials of new antifungals) would be falsely increased by 25%, using a positive BAL GM alone to adjudicate IMI status. Accurate noninvasive tests for diagnosis of IMI are urgently needed. Table: % +BAL GM values in patients with no IMI at various cutoff values. BAL GM ≥ 0.5 BAL GM ≥ 0.8 BAL GM ≥ 1.0 Overall 422217 HM 28147 SOT 1005050 HSCT 30117Disclosures All authors: No reported disclosures.

The prognostic value of lymph node ratio and log odds of positive lymph nodes in patients with lung adenocarcinoma

ObjectiveTo investigate whether lymph node ratio and log odds ratio can be used for predicting the prognosis of patients with lung adenocarcinoma. MethodsA total of 1097 patients with lung adenocarcinoma who underwent complete surgical resection and systematic lymph node dissection between 2008 and 2013 were studied retrospectively. Lymph node ratio was calculated as: positive lymph nodes total lymph nodes . Log odds ratio was calculated as: logpositivelymph nodes+0.5total lymph nodes−positive lymph nodes+0.5. Patients were grouped respectively into 4 groups by the use of recursive partitioning according to their lymph node ratio and log odds ratio. Linear trend χ2 test was used for measuring monotonicity and discriminatory power. ResultsThe 3-year survival rate was 91.0% (89.9%-92.1%) for group 0, 75.2% (71.4%-79.0%) for group 1, 56.5% (51.5%-61.5%) for group 2, and 41.4% (36.4%-46.4%) for group 3 of lymph node ratio, respectively. In addition, the 3-year survival rate was 89.9% (88.7%-91.1%) for group 1, 78.4% (74.4%-82.4%) for group 2, 56.0% (50.9%-61.1%) for group 3, and 41.0% (36.1%-45.9%) for group 4 of log odds ratio, respectively. Univariable and multivariable Cox models identified that both lymph node ratio and log odds ratio were significant prognostic factors for patients' survival. Log-rank test of trend χ2 statistics of both lymph node ratio (P < .001) and log odds ratio (P < .001) showed significant differences. ConclusionsBoth lymph node ratio and log odds ratio can be used as prognostic factors for clinicians to predict patients' prognosis.

Effects of standardized follow-up program among newly diagnosed HIV/AIDS cases in 2010

Objective: To analyze the effects of a follow-up program among newly diagnosed HIV/AIDS cases in 2010 in China. Methods: Database was downloaded on January, 2016 from both HIV/AIDS Case Reporting and Follow-up Cards. Information related to newly diagnosed HIV/AIDS cases in 2010 was extracted from the database. Information on follow-up intervention programs, CD4 testing, antiretroviral treatment, sexual behavior and mortality from 2010 to 2015 were analyzed. Results: Of the newly diagnosed HIV/AIDS cases in 2010, 70.4% were men and 72.0% with Han ethnicity. Heterosexual transmission accounted for 65.8%. The proportion of having received standardized follow-up increased significantly, with an annually upward trend (trend χ2=3 749.77, P<0.01). The proportions of sexual risk behaviors decreased significantly, with safe sexual behaviors over 90%, and having yearly upward trend (trend χ2=16 971.98, P<0.01). Among those eligible for antiretroviral therapy, the proportion of initiation the therapy increased from 56.5% in 2010 to 83.2% in 2015, with significant upward trend, annually (trend χ2=2 504.86, P<0.01). Over the same period, the proportion of deaths decreased from 12.4% in 2010 to 2.4% in 2015, with significant annual downward trend (trend χ2=4 935.89, P<0.01). Conclusion: The standardized follow-up intervention program included the contents of: CD4 testing; counseling and timely referrals to receive antiretroviral therapy etc., which were correlated to the reduction on both high risk sexual behaviors and deaths.

Effects of both folic acid, p16 protein expression and their interaction on progression of cervical cancerization

Objective: To explore the effects of both folic acid, p16 protein expression and their interaction on progression of cervical cancerization. Methods: Participants were pathologically diagnosed new cases, including 80 women with normal cervical (NC), 55 patients with low-grade cervical intraepithelial neoplasia (CINⅠ), 55 patients with high-grade cervical intraepithelial neoplasia (CINⅡ/Ⅲ) and 64 patients with cervical squamous cell carcinoma (SCC). Serum folate levels were detected by microbiological assay method while p16 protein expression levels were measured by Western-blot. In vitro, cervical cancer cell lines C33A (HPV negative) and Caski (HPV16 positive) were treated with different concentrations of folate. Proliferation and apoptosis of cells and the levels of p16 protein expression were measured in groups with different folic acid concentrations. Results: Results showed that the levels of serum folate were (5.96±3.93) ng/ml, (5.08±3.43) ng/ml, (3.92±2.59) ng/ml and (3.18±2.71) ng/ml, and the levels of p16 protein were 0.80±0.32, 1.33±0.52, 1.91±0.77, and 2.09±0.72 in the group of NC, CINⅠ, CINⅡ/Ⅲ and SCC, respectively. However, the levels of serum folate decreased (trend χ2=32.71, P<0.001) and p16 protein expression increased (trend χ2=56.06, P<0.001) gradually along with the severity of cervix lesions. An additive interaction was seen between serum folate deficiency and high expression of p16 protein in the CINⅠ, CINⅡ/Ⅲ and SCC group. Results in vitro showed that, with the increase of folate concentration, the inhibition rate of cell proliferation (C33A: r=0.928, P=0.003; Caski: r=0.962, P=0.001) and the rate on cell apoptosis (C33A: r=0.984, P<0.001; Caski: r=0.986, P<0.001) all increased but the levels of p16 protein expression (C33A: r=-0.817, P=0.025; Caski: r=-0.871, P=0.011) reduced. The proliferation inhibition rate (C33A: r=-0.935, P=0.002; Caski: r=-0.963, P=0.001) and apoptosis rate of cells (C33A: r=-0.844, P=0.017; Caski: r=-0.898, P=0.006) were negatively correlated with the levels of p16 protein expression. Conclusions: Our findings indicated that both serum folate deficiency and high expression of p16 protein could increase the risk of cervical cancer and cervix precancerous lesion, and there was an additive interaction between them. Our findings suggested that folic acid supplementation could reverse the abnormal expression of p16 protein, and effectively promote apoptosis and inhibit proliferation in cervical carcinoma cells.

The characteristics of HIV-positive men who have sex with men in China and predictors of their migration, 2008-2015

Objective: To characterize the migration patterns of men who have sex with men (MSM) living with HIV/AIDS in the period 2008-2015 and to characterize the determinants of their migration. Methods: All identified HIV/AIDS cases transmitted through self-reported homosexual contact reported to the National Case Reporting System(CRS) by the end of December 31, 2015 were included in this study. Data of basic demographic characteristics, household registration and address of the research objects were collected. Retrospective cohort study was used to analyze the migration characteristics of HIV/AIDS cases between 2008 and 2015.We used the χ2 test to analyze their migration patterns and epidemiological characteristics, and multilevel logistic regression to investigate the determinants of migration. Results: While mobile cases comprised 46.1% of the sample (n=54 714), we detected a significant rising trend (χ2=130.93, P<0.001) as this proportion rose from 42.0% (1 335/3 182) in 2008 to 47.9% (15 623/32 610) in 2015. Of the 13 580 mobile cases with Hukou registration in Eastern China, 89.8% (12 201) migrated to other parts of Eastern China. Meanwhile, 52.0% of the 26 088 cases registered in Central China (n=13 570) and 30.5% of the 14 106 registered in Western China (n=4 298) migrated to Eastern China. Furthermore, 96.2% of mobile cases (n=52 627) resided in the urban areas, of which 40.8% (n=21 452) migrated from rural areas to urban areas and 58.4% (n=30 722) migrated between urban areas. The annual proportion of cases who changed their address within 1 year of diagnosis ranged from 12.0%-18.5%. The results of the multilevel model showed that cases who were aged 25-49 years (OR=1.30, 95% CI: 1.26-1.34), single (OR=1.95, 95% CI: 1.87-2.02), and had a high school education or above (OR=1.68, 95% CI: 1.64-1.73) were more likely to migrate. AIDS (OR=0.71, 95% CI: 0.69-0.74), Hukou registration in an urban area (OR=0.63, 95%CI: 0.61-0.65), in Central China (OR=0.84, 95%CI: 0.73-0.97), Western China (OR=0.75, 95%CI: 0.64-0.87), and in regions with a high population density or above-average gross domestic product (GDP) per head (OR=0.77, 95% CI: 0.69-0.87 and OR=0.70, 95% CI: 0.62-0.79, respectively) were negatively associated with migration. Conclusion: The number and proportion of mobile HIV cases showed a rising annual trend. Age, marital status, level of education and disease severity, in addition to the population density and level of economic development of cases' place of origin, were significant determinants of migration.

Performance and learning curve of a surgical care practitioner in completing hip aspirations

INTRODUCTION The roles of non-medically trained practitioners within the NHS are expanding; they are now being employed by many specialties, including surgery, to relieve pressures on healthcare teams. AIMS To investigate the learning curve and competence of an orthopaedic surgical care practitioner (SCP) in performing hip aspirations. METHODS Data were retrospectively collected on 510 orthopaedic hip aspirations, of which 360 were completed by a single SCP and 150 were completed by surgeons before the SCP took over routine aspiration. The 360 aspirations completed by an SCP were separated into groups of 30 by date, so any trend in failure rate could be analysed. Ordinal χ2 analysis was used to analyse this trend and Pearson χ2 analysis was used to analyse differences in failure rates between professionals. RESULTS The hip aspiration failure rate for the SCP was significantly lower than for the surgeons; 8.6% vs 20.7% (P<0.001). With the experience gained in completing the first 210 procedures, the failure rate of the SCP dropped to 3.3% for the remaining 150 procedures. This downward trend in hip aspiration failure rate, with advancing experience of the SCP, was shown to be statistically significant (P=0.006). DISCUSSION SCPs who complete hip aspirations on a regular basis have significantly lower failure rates than surgeons, probably as a result of the learning curve, which this study demonstrated. Other trusts should consider delegating routine hip aspiration work to a designated SCP to lower failure rates.

Acute norovirus gastroenteritis in children in a highly rotavirus-vaccinated population in Northeast Brazil

BackgroundGastroenteritis is one of the most important causes of morbidity and mortality in children and an important etiological agent is norovirus. ObjectiveWe describe the occurrence and characteristics of norovirus diarrhoea in children from Sergipe, Northeast-Brazil, over two consecutive periods of three years following rotavirus vaccine introduction. Study designA cross sectional hospital-based survey conducted from October-2006 to September-2009 and from July-2011 to January-2013. Acute diarrhoea cases had a stool sample collected and tested for norovirus by RT-PCR and positive samples were sequenced. ResultsIn total 280 (19.6%) of 1432 samples were norovirus positive, including 204 (18.3%) of 1113 samples collected during the first period and 76 (23.9%) of 318 collected during the second period. The proportion of children with norovirus infection increased significantly through the second study period (χ2 for trend=6.7; p=0.009), was more frequent in rotavirus vaccinated and in younger children (p<0.001). Of 280 norovirus-positive specimens, 188 (67.1%) were sequenced. Of these, 12 were genogroup I and 176 genogroup II. The main genotype was GII.4 (149/188, 79.3%), followed by GII.2 (6, 3.2%) and GII.6 (5, 2.6%). ConclusionNorovirus annual detection rates increased over the study period. The detection of norovirus was higher among young children.

Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment

The American Heart Association aims to reduce the burden of cardiovascular disease in this decade by improving seven ideal cardiovascular health (CVH) characteristics in the population. The aim of this study was to quantify the association between the American Heart Association's CVH score and values for carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health baseline assessment. The Brazilian Longitudinal Study of Adult Health is a multicenter cohort study of civil servants aged 35 to 74years in Brazil. In this study, the investigators analyzed 9,662 individuals with no previous cardiovascular disease. The distribution of CIMT values (categorized into age-, sex-, and race-specific quartiles) was analyzed according to CVH scores using χ2 trend tests. Linear and multinomial regression models were built to evaluate the association between CIMT and CVH score. A significant increase was observed in the proportion of individuals within the first and second CIMT quartiles, as well as a decrease within the fourth quartile with higher CVH score strata (P for trend<.001). A 1-point increase in CVH score was associated in adjusted models with a decrease of 0.011mm in CIMT and an odds ratio of 0.79 (95% CI, 0.77-0.81) of having CIMT in the fourth quartile. However, nearly 16% of individuals with optimal CVH scores had CIMT values in the highest quartile. In this study, significant associations were found between CIMT and CVH score in a large sample of middle-aged adults. However, a high CVH score did not warrant the absence of a significant subclinical atherosclerotic burden.

Application of " Internet Plus" AIDS prevention services among men who have sex with men in Guangzhou, China: results from 2010 to 2015

Objective: To introduce the development strategy of " Internet Plus" AIDS prevention services and its implementation results from 2010 to 2015 in Guangzhou, China. Methods: A gay men's health column was created for an active website aimed at men who have sex with men(MSM), in collaboration with local community organizations and the Guangzhou CDC. We designed intervention tools(including scenario-based applications and HIV risk self-assessment systems)and an online HIV testing service platform, integrated with applied psychology and behavioral theory as well as the " Internet Plus" concept, to intervene in HIV infection risk factors among MSM. Data of clients who accessed the " Internet Plus" AIDS services from 2010 to 2015 were used to evaluate service operation. Six-year consecutive surveys, conducted between April and July of each service year, were collected using a national AIDS sentinel surveillance questionnaire. For each year of surveillance, information on HIV prevalence, HIV interventions received during the past year, unprotected anal intercourse in the past 6 months, and HIV testing in the past year were compared using the chi-squared(χ2)test, to roughly reflect the effect of"Internet Plus" AIDS prevention services. Results: As of 31 December 2015, a total of 34 395 MSM had received " Internet Plus" services and HIV testing. The number of MSM tested increased from 2 338 in 2010 to 8 054 in 2015. From 2010 to 2015, newly identified HIV cases in each year were 59, 166, 312, 283, 291, and 270, which accounted for 25.0%, 32.8%, 38.8%, 35.1%, 30.5%, and 23.2% of MSM HIV cases of Guangzhou, respectively. Sentinel surveillance data showed that during the study period, 3 047 MSM were investigated, with 405, 400, 401, 633, 608, and 600 each year, respectively. The proportion of participants who had received any HIV intervention during the past year was 74.3%(301), 70.8%(283), 83.3%(334), 85.0%(538), 69.1%(420), and 83.8%(503)each year, respectively(trend χ2=6.53, P=0.011). HIV testing done during the past year accounted for 44.0%(178), 44.3%(177), 49.4%(198), 53.4%(338), 56.1%(341), and 60.2%(361)each year, respectively(trend χ2=40.83, P<0.001). Unprotected anal intercourse in the past 6 months accounted for 59.3%(240), 62.0%(248), 56.6%(227), 57.0%(361), 48.4%(294), and 43.7%(262)each year, respectively(trend χ2=42.21, P<0.001). Conclusion: The"Internet Plus"AIDS prevention services in this study represent a manner to enhance traditional HIV prevention strategies. We found these services to be effective in implementation of the national AIDS control and prevention strategy, especially for the expansion of intervention, testing, and case identification among high-risk populations.

Permanent caries experience is associated with primary caries experience: a 7-year longitudinal study in China.

The aim of this study was to evaluate the association between caries experience in primary teeth and caries experience in permanent teeth in a longitudinal study. Teeth were examined at 5 years of age and a follow-up examination was conducted 7 years later at 12 years of age in all children from Jiading District, Shanghai, China. A total of 1885 participants were recruited in the study; 1683 students were followed up and 202 students (10.7%) were lost to follow up. Data were analyzed using the chi-square test, t-test and risk ratio. The followed-up samples comprised 883 boys (52.5%) and 800 girls (47.5%). At initial examination, the prevalence of dental caries was 67.4% in boys and 66.5% in girls (χ² = 0.2, P = 0.70), with mean decayed, missing and filled teeth (dmft) scores of 3.5 ± 0.1 and 3.4 ± 0.1, respectively (t = 0.1, P = 0.90). At follow-up, the prevalence of dental caries was 33.9% in boys and 37.9% in girls (χ² = 2.9, P = 0.11), with mean DMFT scores in permanent teeth of 0.7 ± 0.0 and 0.8 ± 0.1, respectively (t = 1.2, P = 0.24). The group of 5-year-olds with caries had a significantly higher prevalence of caries in permanent teeth (45.5%) at 12 years of age than the group of 5-year-olds without caries (16.0%) (χ2 = 141.1, P < 0.001, risk ratio = 1.5). Caries risk in permanent teeth was significantly higher with greater dmft scores (χ2 for trend = 31.1, P < 0.001). Caries in primary teeth is a major risk factor for caries in permanent teeth. The likelihood of caries in permanent teeth is higher with greater dmft scores in primary teeth.

Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism

To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital. A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry. A total of 50 patients (15 men, 35 women; their median age was 70.5 years) with HA-VTE were included in the HA-VTE registry in January 2014 to June 2015. Assessment of a trend in the prevalence of HA-VTE when introducing CDSS to prevent VTE showed its statistically significant decline in the total number of HA-VTE cases (χ2=7.325, df=1; p=0.0068) and in that of HA-VTE in surgical patients (χ2=7.266, df=1; p=0.0070). The statistical significance of χ2 for linear trend was not achieved for medical patients, which is probably due to the small sample size (χ2=2.764, df=1; p=0.0964). While introducing CDSS, there was a statistically significant reduction in the incidence of postoperative VTE from 8.76 to 4.17 cases per 1000 interventions (χ2=5.347, df=1; p=0.0208; the absolute values of HA-VTE and surgical interventions were used for the calculation). The proposed comprehensive approach can substantially increase the detection rate of HA-VTE and decrease its incidence rates. This requires a personified assessment of the risk of VTE and hemorrhage in all hospitalized patients on day 1 of their admission, timely initiation of recommended VTE prophylaxis, and dynamic assessment of the risk of VTE and hemorrhage for timely correction of the prophylaxis.

OP.3C.04] PREDICTING POSTURAL HYPOTENSION, FALLS, AND COGNITIVE IMPAIRMENT

Objective: Over three million people aged over 65 fall each year in the UK. Postural hypotension (PH) is a risk factor for falls. It is associated with excess mortality, and may affect cognition. PH is not routinely checked for in UK clinical practice. We studied the InCHIANTI dataset to derive and validate a simple prediction tool designed to facilitate identification of subjects to be checked for PH. Design and method: InCHIANTI is a population-based study of ageing. It recruited subjects from population registries in Chianti, Italy in 1998 and they were followed up triennially. Blood pressure (BP) at recruitment was measured after resting supine, and one and three minutes after standing, using a mercury sphygmomanometer. Systolic PH was defined as a > = 20 mmHg fall in supine BP on standing. Subjects were randomised to derivation or validation cohorts; allocation was undertaken blinded to PH status and medical history. Candidate predictor variables identified from literature searches were tested for univariable cross sectional associations with PH using χ2 tests. Those with significant associations were entered into multivariable linear regression models, and used to derive simple and weighted prediction scores (DROP scores). DROP scores were tested in the validation cohort for prediction of PH, future falls, cognitive decline and mortality rates. Results: PH was present in 56/726 (7.7%) of the derivation cohort and 45/727 (6.2%) of the validation cohort (p = 0.25). PH was associated with age > = 65, falls in the preceding year, diabetes, previous stroke, hypertension and Parkinson's disease. A simple score summing numbers of these variables performed equally well as weighted scores (AUROC 0.67 (0.59 to 0.74); p < 0.001). Rising DROP scores were incrementally predictive of future falls (χ2 for trend p < 0.01), increasing rates of decline in mini mental state examination (ANOVA p < 0.001) and mortality (HR 1.8 (1.6 to 2.0) per unit increment in DROP score; p < 0.001; figure).Conclusions: The DROP score can predict presence of PH, future falls, and increased rates of mortality and cognitive decline. Application of the score could facilitate detection and management of PH. External validation of the DROP score is underway.

Effect of Stage Migration on Bladder Cancer: A Slow but Steady Improvement in Long-Term Survival Rates After Radical Cystectomy in Previous 25 Years

IntroductionWe evaluated the effect of the year of surgery on the clinical, pathologic, and oncologic outcomes of patients with bladder cancer (BCa) treated with radical cystectomy (RC) at a single institution. Materials and MethodsThe present study included 1253 consecutive patients with BCa treated with RC and extended pelvic lymphadenectomy at a single institution from January 1990 to December 2014. Analysis of variance and χ2 trend tests were used to report the clinical and pathologic characteristics of the cohort over time. Multivariable Cox regression analysis was used to test the relationship between the year of surgery and recurrence, cancer-specific mortality (CSM) and overall mortality (OM). ResultsConsidering the clinical characteristics, patient age (P = .1) and gender (P = .2) remained steady during the study period. In contrast, the body mass index (P < .005) increased. Also, of the pathologic features, carcinoma in situ detection (P < .001) showed an increasing rate, and pathologic stage T3-T4 (P = .005) showed a decreasing trend. The number of lymph nodes removed increased during the study period (P < .001), resulting in an increased number of positive nodes (P < .001). However, the rate of lymph node invasion (P = .1) remained stable in the overall population. Multivariable Cox regression analyses revealed the year of surgery as a predictor of recurrence (hazard ratio [HR], 0.97), CSM (HR, 0.97), and OM (HR, 0.98), with a slight, but constant, reduction in all survival outcomes (P < .04 for all). ConclusionChanges were recorded considering the patient and tumor characteristics across the previous 25 years. These variations directly reflect the differences in long-term survival expectations we recorded.

Abstract 5026: EGFR copy number alterations in primary tumors, metastatic lymph nodes and recurrent tumors in areca-quid associated oral squamous cell carcinoma

Abstract EGFR and downstream signaling pathway plays important roles in the tumorigenesis in oral squamous cell carcinoma (OSCC). Gene copy number alteration is one the mechanism overexpressing the EGFR protein. We previously demonstrated that EGFR gene amplification was related with lymph node metastasis, tumor invasion and perineural invasion. We appraise the hypothesis that the EGFR gene copy number alteration in the primary tumor can predict that in recurrent tumors or in lymph node metastatic foci. Of 167 primary OSCCs, fluorescence in-situ hybridization (FISH) study showed EGFR polysomy in 19 (11.4%) patients and amplification in 33 (19.8%) patients. EGFR gene amplification was related with lymph node metastasis (χ2 trend test: P = 0.018) Of 57 metastatic lymph nodes, 9 (15.8%) had EGFR polysomy and 14 (24.6%) had EGFR gene amplification. The concordance rate of EGFR gene copy number in primary tumor and lymph node metastasis was 68.4% (McNemar test: P = 0.389). Of 41 recurrent tumors, 5 (12.2%) had EGFR polysomy and 5 (12.2%) had gene amplification. The concordance rate of EGFR gene copy number between primary tumor and recurrence tumor was 65.9% (McNemar test: P = 0.510). From our results, we can predict two-thirds of the EGFR gene copy number alteration in the lymph node metastasis or the recurrent tumor from the analysis of primary tumor. In clinical scenario, for OSCC patients that the lymph nodes or the recurrent tumors are unavailable for EGFR gene copy number analysis, studies from the primary tumors could provide part of the EGFR clonal information in the metastatic or recurrent lesions. Citation Format: Shiang-Fu Huang, Huei-Tzu Chien, Sou-De Cheng, Chun-Ta Liao, Hung-Ming Wang, Ling-Ling Hsieh. EGFR copy number alterations in primary tumors, metastatic lymph nodes and recurrent tumors in areca-quid associated oral squamous cell carcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5026.

Consistently high HIV prevalence among men who have sex with men in Chengdu city from 2009 to 2014.

To describe the trends of the HIV epidemic among men who have sex with men (MSM) in Chengdu city, China, consecutive cross-sectional surveys were conducted by the Chengdu Center for Disease Control and Prevention. These surveys were carried out between 2009 and 2014 according to the protocol of the national HIV Sentinel Surveillance System. For the 2422 MSM who participated in the survey, the overall HIV prevalence was 15.5% (375/2422, 95% CI 14.0-16.9%). Between 2009 and 2014, the HIV prevalence of MSM remained high, with HIV-positivity rates of 15.0%, 15.1%, 16.3%, 13.9%, 17.8% and 14.0% each year respectively (χ2 for trend = 0.008, P = 0.931). However, the majority (89.8%) of participants had had anal sex in the six months prior to the interview, and the percentage always using condoms during anal sex increased over the study period (36.7% in 2009, 39.8% in 2010, 36.9% in 2011, 46.2% in 2012, 65.1% in 2013, 49.0% in 2014; Chi-square for trend = 49.883, P < 0.001). HIV prevalence among MSM in Chengdu city has remained high. Given the continuing high levels of unprotected anal intercourse and high HIV prevalence among MSM, more effective intervention strategies are required to increase the coverage of MSM by risk-reduction interventions and to promote HIV testing among this population.

Increasing incidence of Clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the Italian region with the oldest population.

Limited information is available on the incidence of Clostridium difficile infections (CDIs) in Italian hospitals. In this study, we assessed the changes in the incidence of CDI over a 5-year period in a teaching hospital in Liguria, the Italian region with the oldest population. Secondary endpoints were the development of severe CDI and 30-day mortality. The annual incidence of CDI/10000 patient-days significantly increased from 0·54 in 2010 to 3·04 in 2014 (χ 2 for trend, P < 0·001). The median age of patients with CDI was 81 years. As many as 81% and 89% of these patients had comorbid conditions and previous exposure to antibiotics, respectively. In the multivariate analysis of risk factors for severe CDI, previous therapy with histamine 2 blockers and low serum albumin were associated with severe CDI, while diabetes appeared to be protective. In the multivariate model of risk factors for 30-day mortality, high leukocyte count, low serum albumin, and increased serum creatinine were unfavourably associated with outcome. Strict adherence to infection control measures was of utmost importance to counteract the increasing incidence of CDI in our hospital, particularly because of the advanced age of the patients and their very high frequency of chronic conditions and use of antibiotics, which readily predispose them to the development of CDI.

Barriers against split-dose bowel preparation for colonoscopy

ObjectiveAlthough split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim...

Myeloid deprived suppressive cell to mediate the prognostic value of neutrophil to hemoglobin ratio for hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization.

292 Background: The prognosis of hepatocellular carcinoma (HCC) patients receiving transcatheter arterial chemoembolization (TACE) is far from being identified. The present study aimed to assess role of blood cell counts, routine liver function tests and neutrophil to hemoglobin ratio (NHR) in predicting the progression-free survival (PFS) of these patients. Methods: A total of 243 HCC patients receiving TACE were analyzed retrospectively. Results: Cancer of the Liver Italian Program (CLIP) score system was identified to be the best score system among current 12 staging systems for this patient subgroup according akaike information criterion (AIC) index and linear trend χ2. Then, the novel prognostic value of parameters was determined by integration into CLIP score system. As a result, NHR were confirmed to an independent predictor for PFS of HCC patients receiving TACE (p = 0.001) with the other parameters, including neutrophil and neutrophil-lymphocyte ratio (NLR), failed to reach statistical significance. Moreover, NHR improved the performance of CLIP by adjusted into it, thus improved the discriminatory ability. Furthermore, NHR were defined value ≤ 0.02 as low level and &gt; 0.02 as high level, according to which patients were dichotomized into two groups. HCC patients receiving TACE with low NHR presented higher 1 year disease control rate (DCR) (50.0% vs 39.35%) and 2 year DCR (45.4% vs 27.0%) compared with patients with high NHR level. Besides, NHR level was associated with prognostic factors such as portal vein thrombosis and distant metastasis. Furthermore, in order to determine the mechanism of predictive value of AHR, we tested the proportion of myeloid deprived suppressive cell (MDSC) in peripheral blood mononuclear cells (PBMC) of 43 HCC patients. It was revealed that MDSC was positively correlated with neutrophil (P&lt; 0.05). Since MDSC was cancer promoter, it might be the mechanism of the prognostic value of NHR. Conclusions: The present study firstly identified NHR as an independent prognostic factor in HCC patients receiving TACE. The positive correlation of MDSC and neutrophil might be the latent mechanism.

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience.

To the best of our knowledge, none of the prognostic staging systems for hepatocellular carcinoma (HCC) patients who underwent sorafenib therapy is universally adopted or preferred. In the present study, we aimed to compare prognostic ability among five prognostic systems, including the Japan Integrated Staging (JIS) system, the Barcelona Clinic Liver Cancer classification system, the tumor-node-metastasis classification system, the Cancer of the Liver Italian Program scoring system and the Chinese University Prognostic Index (CUPI) scoring system for HCC patients who received sorafenib therapy. A total of 143 HCC patients treated with sorafenib were analysed. We compared prognostic ability among the five prognostic systems using the likelihood ratio (LR) χ2 test, linear trend χ2 test and concordance index (c-index). Our cohort included 114 men and 29 women. The median patient age was 71 years (range, 45-89 years). A total of 102 patients were classified as Child-Pugh A and 41 as Child-Pugh B, whereas 31 patients (21.7%) had portal vein invasion and 63 (44.1%) extrahepatic metastases. The median survival time was 6.9 months. In the LR χ2 test, the CUPI scoring system had the highest value (35.804), followed by the JIS system (17.469). In the linear trend χ2 test, the CUPI scoring system had the highest value (17.523), followed by the JIS system (15.819). In addition, the JIS system had the highest value in the 6-month c-index (0.659) as well as in the 1-year c-index (0.674). However, the CUPI classification system had the lowest value in the 1-year c-index (0.590). In conclusion, the JIS system may be an appropriate staging system for HCC patients undergoing sorafenib therapy.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study.

AIMTo investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.METHODSA total of 1736 patients with chronic digestive system diseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A self-designed General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient’s general information, which included demographic data (including age, sex, marital status, and education) and disease characteristics (including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).RESULTSThe overall detection rate was 31.11% (540/1736) for depression symptoms alone, 27.02% (469/1736) for anxiety symptoms alone, 20.68% (359/1736) for both depression and anxiety symptoms, and 37.44% (650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression (44.06%) and anxiety symptoms (33.33%). χ2 trend test showed: the higher the body mass index (BMI), the lower the detection rate of depression and anxiety symptoms (χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms (χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms (χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression (57.55%) and anxiety (55.19%), followed by patients with liver cirrhosis (41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease.CONCLUSIONDepression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.