Αρχειοθήκη ιστολογίου

Δευτέρα 2 Μαΐου 2022

Incidences and characteristics of primary lung malignancies in childhood i

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Abstract

Background: Primary lung malignancies are a heterogeneous group of cancers that occur very rarely in childhood. Due to limited knowledge of their epidemiologic and clinical features, these tumors present a challenge to the treating physicians. This study aimed to increase the knowledge about the occurrence of primary lung malignancies in childhood in Germany.

Materials and methods: Pseudonymized data of cases recorded at the German Center for Cancer Registry Data (ZfKD) between 1990 and 2017 were retrieved. Primary lung malignancies were identified using the ICD- and ICD-O classification. Numbers were compared to those reported to the German Childhood Cancer Registry (GCCR). Crude incidence rates were calculated using the ZfKD database.

Results: A total of 168 patients diagnosed with primary lung malignancies in the age below 19 years were identified from the ZfKD. The median age at diagnosis was 13 years. The most common tumor entities were lung carcinoids (n = 49), lung carcinoma (n = 36), and pleuropulmonary blastoma (n = 14). An unexpected accumulation of lung cancer cases was noted in the first year of life without a clearly specified histopathological diagnosis. A substantial discrepancy in the numbers of primary lung malignancies between ZfKD and GCCR was found.

Conclusions: We present population-based data on the occurrence of primary childhood lung malignancies in Germany, which were more frequent than previously anticipated but likely remained underreported. For better understanding and optimal treatment of these entities, cancer registration needs to be improved through mandatory reporting to the GCCR and regular data sharing between GCCR, population-based and clinical cancer registries.

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Hypomethylating agent and venetoclax with FLT3 inhibitor “triplet” therapy in older/unfit patients with FLT3 mutated AML

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Investigating aluminum cookpots as a source of lead exposure

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Journal of Exposure Science & Environmental Epidemiology, Published online: 02 May 2022; doi:10.1038/s41370-022-00431-y

Investigating aluminum cookpots as a source of lead exposure in Afghan refugee children resettled in the United States
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Hypomethylating agent and venetoclax with FLT3 inhibitor “triplet” therapy in older/unfit patients with FLT3 mutated AML

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Blood Cancer Journal, Published online: 02 May 2022; doi:10.1038/s41408-022-00670-0

Hypomethylating agent and venetoclax with FLT3 inhibitor "triplet" therapy in older/unfit patients with FLT3 mutated AML
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Predicted cardiovascular disease risk and prescribing of antihypertensive therapy among patients with hypertension in Australia using MedicineInsight

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Journal of Human Hypertension, Published online: 02 May 2022; doi:10.1038/s41371-022-00691-z

Predicted cardiovascular disease risk and prescribing of antihypertensive therapy among patients with hypertension in Australia using MedicineInsight
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Screening auf Mangelernährung bei Kopf-Hals-Tumor-Patienten vor onkologischer Therapie

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Laryngorhinootologie
DOI: 10.1055/a-1823-1143

Hintergrund Patienten mit einem Kopf-Hals-Tumor besitzen ein hohes Risiko, peri- bzw. posttherapeutisch eine Mangelernährung zu entwickeln, die den onkologischen Therapieerfolg entscheidend beeinflussen kann. Prätherapeutisch ist hierüber wenig bekannt. Daher ist das Ziel der vorliegenden Studie die prätherapeutische systematische Erfassung des Ernährungszustandes und des Risikos für das Auftreten einer Mangelernährung. Material und Methoden Bei 102 Kopf-Hals-Tumor-Patienten erfolgte die prätherapeutische Untersuchung des Ernährungszustandes via Body-Mass-Index (BMI) sowie des Risikos für Mangelernährung via „Nutritional Risk Screening" (NRS). An möglichen Einflussfaktoren wurden Tumorstadium, -lokalisation, Patientenalter, -geschlecht und das Bestehen einer oropharyngealen Dysphagie, identifiziert über Flexible Endoskopische Evaluation des Schluckvorgangs (FEES), analysiert. Ergebnisse Eine Mangel- bzw. Unterernährung, bemessen am BMI, bestand prätherapeutisch bei bereits 6% der Patienten, ein Risiko für Mangelernährung laut NRS bei 27%, eine oropharyngeale Dysphagie bei 15%. Nur das Vorliegen einer oropharyngealen Dysphagie erwies sich in der linearen Regression als signifikanter Einflussfaktor auf das Risiko einer Mangelernährung (β = 0,380/3,776; p < 0,001). Schlussfolgerungen Bereits prätherapeutisch besteht ein Risiko einer Mangelernährung bei einem Viertel der Kopf-Hals-Tumor-Patienten. Um dieses frühzeitig zu erkennen und um bereits zu Beginn der onkologischen Therapie Maßnahmen zur ihrer Vermeidung einzuleiten, empfiehlt sich daher bereits prätherapeutisch die Untersuchung des Schluckvermögens sowie das systematische Screening auf Mangelernährung via NRS.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

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imageBACKGROUND Noncompressible torso hemorrhage management remains a challenge especially in the prehospital setting. We evaluated a device designed to occlude the aorta from the stomach (gastroesophageal resuscitative occlusion of the aorta [GROA]) for its ability to stop hemorrhage and improve survival in a swine model of lethal liver laceration and compared its performance to resuscitative endovascular balloon occlusion of the aorta (REBOA) and controls. METHODS Swine (n = 24) were surgically instrumented and a 30% controlled arterial hemorrhage over 20 minutes was followed by liver laceration. Animals received either GROA, REBOA, or control (no treatment) for 60 minutes. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional 4 hours. RESULTS The liver laceration resulted in the onset of class IV shock. Mean arterial blood pressure (MAP) (standard deviation) decreased from 84.5 mm Hg (11.69 mm Hg) to 27.1 mm Hg (5.65 mm Hg) at the start of the intervention. Seven of eight control animals died from injury prior to the end of the intervention period with a median survival (interquartile) time of 10.5 minutes (12 minutes). All GROA and REBOA animals survived the duration of the intervention period (60 minutes) with median survival times of 86 minutes (232 minutes) and 79 minutes (199 minutes) after resuscitation, respectively. The GROA and REBOA animals experienced a significant improvement in survival compared with controls (p = 0.01). Resuscitative endovascular balloon occlusion of the aorta resulted in higher MAP at the end of intervention 114.6 mm Hg (22.9 mm Hg) compared with GROA 88.2 mm Hg (18.72 mm Hg) (p = 0.024), as well as increased lactate compared with GROA 13.2 meq·L−1 (1.56 meq·L−1) versus 10.5 meq·L− 1 (1.89 meq·L−1) (p = 0.028). Histological examination of the gastric mucosa in surviving animals revealed mild ischemic injury from both GROA and REBOA. CONCLUSION The GROA and REBOA devices were both effective at temporarily stanching lethal noncompressible torso hemorrhage of the abdomen and prolonging survival.
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Extravasation and outcomes in computed tomography and angiography in patients with pelvic fractures requiring transcatheter arterial embolization: A single-center observational study

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imageBACKGROUND Extravasation on contrast-enhanced computed tomography (CECT) is a helpful indicator of the need for transcatheter arterial embolization (TAE) for pelvic fractures. However, previous reports were inconsistent on cases in which angiography is necessary, even though there is no extravasation on computed tomography. This study aimed to describe and analyze the contradictory findings in cases where extravasation is observed on angiography but not on CECT, to contribute to improved management of patients with pelvic fractures. METHODS This was a retrospective single-center study. Patients with pelvic fractures who underwent CECT and TAE between 2014 and 2020 were included. We classified the patients into three groups: CECT and angiography with extravasation (CT+Angio+), CECT with no extravasation and angiography with extravasation (CT−Angio+), and CECT with extravasation and angiography without extravasation (CT+Angio−). RESULTS A total of 113 patients were included in the study: the CT+Angio+ group had 54 patients, CT−Angio+ group, 47; and CT+Angio− group, 12. The CT−Angio+ group had a significantly longer time from arrival to CECT than the CT+Angio+ group (27 minutes vs. 23 minutes, p
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Evaluating the complex association between Social Vulnerability Index and trauma mortality

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imageINTRODUCTION Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood. METHODS In this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality: (1) an unadjusted model, (2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard. RESULTS We identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30–2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80–1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of >0.9, any Abbreviated Injury Scale score of >5, or in need of a blood transfusion (p
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Direct to OR resuscitation of abdominal trauma: An NTDB propensity matched outcomes study

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imageBACKGROUND Direct to operating room resuscitation (DOR) is used by some trauma centers for severely injured trauma patients as an approach to minimize time to hemorrhage control. It is unknown whether this strategy results in favorable outcomes. We hypothesized that utilization of an emergency department operating room (EDOR) for resuscitation of patients with abdominal trauma at an urban Level I trauma center would be associated with decreased time to laparotomy and improved outcomes. METHODS We included patients 15 years or older with abdominal trauma who underwent emergent laparotomy within 120 minutes of arrival both at our institution and within a National Trauma Data Bank sample between 2007 to 2019 and 2013 to 2016, respectively. Our institutional sample was matched 1:1 to an American College of Surgeons National Trauma Databank sample using propensity score matching based on age, sex, mechanism of injury, and abdominal Abbreviated Injury Scale score. The primary outcome was time to laparotomy incision. Secondary outcomes included blood transfusion requirement, intensive care unit (ICU) length of stay (LOS), ventilator days, hospital LOS, and in-hospital mortality. RESULTS Two hundred forty patients were included (120 institutional, 120 national). Both samples were well balanced, and 83.3% sustained penetrating trauma. There were 84.2% young adults between the ages of 15 and 47, 91.7% were male, 47.5% Black/African American, with a median Injury Severity Score of 14 (interquartile range [IQR], 8–29), Glasgow Coma Scale score of 15 (IQR, 13–15), 71.7% had an systolic blood pressure of >90 mm Hg, and had a shock index of 0.9 (IQR, 0.7–1.1) which did not differ between groups (p > 0.05). Treatment in the EDOR was associated with decreased time to incision (25.5 minutes vs. 40 minutes; p ≤ 0.001), ICU LOS (1 vs. 3.1 days; p
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Beta blockade in TBI: Dose-dependent reductions in BBB leukocyte mobilization and permeability in vivo

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imageBACKGROUND Traumatic brain injury (TBI) is accompanied by a hyperadrenergic catecholamine state that can cause penumbral neuroinflammation. Prospective human studies demonstrate improved TBI survival with beta blockade (bb), although mechanisms remain unclear. We hypothesized that deranged post-TBI penumbral blood brain barrier (BBB) leukocyte mobilization and permeability are improved by bb. METHODS CD1 male mice (n = 64) were randomly assigned to severe TBI—controlled cortical impact: 6 m/s velocity, 1 mm depth, 3 mm diameter—or sham craniotomy, and IP injection of either saline or propranolol (1, 2, or 4 mg/kg) every 12 hours for 2 days. At 48 hours, in vivo pial intravital microscopy visualized live endothelial-leukocyte (LEU) interactions and BBB microvascular leakage. Twice daily clinical recovery was assessed by regaining of lost body weight and the Garcia Neurological Test (motor, sensory, reflex, balance assessments). Brain edema was determined by hemispheric wet-to-dry ratios. RESULTS Propranolol after TBI reduced both in vivo LEU rolling and BBB permeability in a dose-dependent fashion compared with no treatment (p
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Artificial Enamel – Stronger and Durable finds other uses beyond Medicine

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Artificial Enamel Developed in Lab stronger than Natural Enamel

Researchers have successfully designed artificial Enamel in their lab, which might not be used in repairing or replacing lost Enamel on natural teeth but can be used in other areas beyond medicine. Artificial Enamel can be used in creating Body armor, stronger body for Vehicles, hardening surfaces of many appliances and even in building materials which can help in protecting against Earthquakes as wel l. The Artificial or Lab grown Enamel has been found to out perform the natural enamel in six different areas such as Elasticity, absorbing vibrations, strength etc. Enamel is a Complex structure and to replicate it and mimic all its properties is a big step in the right direction. Natural Enamel is the hardest tissue in the human body which is strong enough to not crack on applying hard forces for lifetime and also elastic enough to bear all types of forces. Natural Enamel has many nested modes of organization like wool fibers spun into yarn and then knitted in to a cable knit sweater, Calcium, phosphorus and oxygen atoms must come together in a complex repeating pattern to form crystalline wires. To achieve artificial enamel structure, researchers used extreme temperature to arrange the wires in an orderly formation to achieve the required arrangement. Earlier scientists unsuccessfully used peptides - short chains of amino acids which help in building proteins to mimic enamel. With the new attempt Researchers used malleable metal based coating to encase the wires to give extra strength
Artificial Enamel Developed in Lab stronger than Natural Enamel

According to Nicholas Kotov, a chemical engineer at the University of Michigan, Ann Arbor, said - What makes the artificial Enamel more like Natural Enamel is the coating on the crystalline wires which makes the Artificial Enamel more resilient and less likely to break, the soft material covering the wires can absorb high amount of pressures and shock. The magnesium rich coating of the Natural Enamel has been replaced with Zirconium Oxide giving it more strength and also non toxic. The use of these materials helped in achieving a material which was hard and could be cut into desired shapes using a diamond based saw. The team of Researchers have tested the hardness and elasticity of the new Artificial Enamel material by making a small notch on the surface and applied pressure on it until it gave in and formed a fracture. The toughness of the material was determined by seeing the pressure applied and the length of the crack, it also helped in determining the strain resistance of the enamel. The researchers even tried Artificial Enamel against Natural Enamel where the results where in favor of lab grown enamel outperforming the Natural one. The cells (Ameloblasts) which form Enamel die as soon as the tooth emerges from the gums hence Enamel cannot repair itself. Most dental visits are due to Caries in the Enamel and n neglecting, it might lead to tooth loss as well. To replace damaged Enamel, Dentists use artificial filling materials such as GIC, Composite, Dental Amalgam, etc which do not have the same properties such as Natural Enamel to withstand the Oral forces for decades. Use of this Artificial Enamel in repairing natural Enamel might still take some time as bonding Artificial Enamel to Natural Enamel needs to first heated to 300 degrees C first, Frozen and then cut into the required shape which is not so easy in a Clinical practice. References: 
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