There is a growing body of evidence linking ambient air temperature and adverse health effects, in the form of hospitalization or even increased mortality mainly due to respiratory and ...cardio/cerebro-vascular illnesses. In the present study, we examine the association between high ambient air temperature and cardiovascular as well as respiratory mortality for the population of the greater area of Thessaloniki, Greece, taking into account the role of particulate pollution as a potential confounder.
A mixed Poisson regression model, using a quasi-likelihood function to account for potential over-dispersion in the outcome distribution given covariates, was combined with distributed lag non-linear models, to estimate the non-linear and lag patterns in the association between mortality and daily mean temperature from 1999 to 2012.
A direct heat effect was found, as the mortality risk increased sharply above the temperature threshold of 33 °C, suggesting a significant effect of high temperatures on mortality on the same and next day of the heat events (lags 0–1) which was retained for a week, whereas a harvesting effect was noticed for the following days. Cardiovascular and respiratory mortality risk increased by 4.4% (95% CI 2.7%–6.1%) and 5.9% (95% CI 1.8%–10.3%) respectively on the same and following day of a heat event, whereas the risk dropped steeply in the following days. Particulate matter did not confound the association between high temperature and mortality in this population.
There is a significant association between mortality and hot temperatures in Thessaloniki, Greece. Reduction in exposure to increased temperatures, as part of prevention measures and strategies, should be considered for vulnerable subpopulations.
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•High ambient temperature is a known risk factor for cardio-respiratory mortality.•In Thessaloniki, this association is examined using DLNM models.•Above 33 °C, mortality risk increased for the same and next day of the heat event.•Mortality risk dropped steeply in following days, demonstrating a harvesting effect.
Citrus is one of the most economically important horticultural crops in the world. Citrus are vulnerable to the postharvest decay caused by Penicillium digitatum and P. italicum, which are both wound ...pathogens. To date, several non-chemical postharvest treatments have been investigated for the control of both pathogens, trying to provide an alternative solution to the synthetic fungicides (imazalil, thiabendazole, pyrimethanil, and fludioxonil), which are mainly employed and may have harmful effects on human health and environment.
The current study emphasizes the non-chemical postharvest treatments, such as irradiations, biocontrol agents, natural compounds, hot water treatment (HWT), and salts, on the prevention of decay caused by P. digitatum and P. italicum, also known as green and blue molds, respectively. The mode of action of each technique is presented and comprehensively discussed.
In vivo and in vitro experiments in a laboratory scale have shown that the control of green and blue molds can be accomplished by the application of non-chemical treatments. The mechanisms of action of the non-chemical techniques have not been clearly elucidated. Several studies have mentioned that the application of non-chemical treatments results in the synthesis of secondary metabolites with antifungal activities (i.e. polyphenols, phytoalexins) in fruit surface. Moreover, non-chemical treatments may exert direct effects on fungal growth, such as disruption of cell walls, inhibition of metabolic respiration, and disruption of energy production related enzymes.
•Non-chemical treatments for green and blue mold control.•Essential oils can control the germination of blue and green molds.•Irradiations may effectively control the decay caused by Penicillium spp.•Yeasts and bacteria can been used as biocontrol agents against green and blue molds.
Background
Immune checkpoints inhibitors (ICIs) have emerged as a treatment option for several malignancies. Nivolumab, pembrolizumab, nivolumab plus ipilimumab, and atezolizumab plus bevacizumab ...have been approved for the management of advanced‐stage hepatocellular carcinoma (HCC). We aimed to systematically review the literature and summarize the characteristics and outcomes of patients with HCC treated with ICIs.
Methods
A systematic literature search of PubMed, the Cochrane Library, and ClinicalTrials.gov was performed according to the PRISMA statement (end of search date: November 7, 2020). Quality of evidence assessment was also performed.
Results
Sixty‐three articles including 2,402 patients were analyzed, 2,376 of whom received ICIs for unresectable HCC. Response to ICIs could be evaluated in 2,116 patients; the overall objective response rate (ORR) and disease control rate (DCR) were 22.7% and 60.7%, respectively, and the mean overall survival (OS) was 15.8 months. The ORR, DCR, and OS for nivolumab (n = 846) were 19.7%, 51.1%, and 18.7 months, respectively; for pembrolizumab (n = 435) they were 20.7%, 64.6% and 13.3 months, respectively. The combination of atezolizumab/bevacizumab (n = 460) demonstrated an ORR and DCR of 30% and 77%, respectively. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre‐LT for bridging, 14 for post‐LT recurrence); fatal graft rejection was reported in 40.0% (n = 6/15) and mortality in 80.0% (n = 12/15).
Conclusion
ICIs are safe and effective against unresectable HCC, but caution is warranted regarding their use in the LT setting because of the high graft rejection rate.
Implications for Practice
This systematic review pooled the outcomes from studies reporting on the use of immune checkpoint inhibitors (ICIs) for the management of 2,402 patients with advanced‐stage hepatocellular carcinoma (HCC), 2,376 of whom had unresectable HCC. The objective response rate and disease control rate were 22.7% and 60.7%, respectively, and the mean overall survival was 15.8 months. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre‐LT for bridging, 14 for post‐LT recurrence). Six of these patients experienced graft rejection (40.0%).
Favorable initial survival outcomes of immune checkpoint inhibitor (ICI) treatment have led to broader use as first‐ or second‐line options in patients with unresectable hepatocellular carcinoma (HCC). This article summarizes the available data on characteristics and outcomes of patients with HCC treated with ICIs.
Abstract
BACKGROUND
Pediatric epilepsy surgery is a treatment modality appropriate for select patients with debilitating medication-resistant seizures. Previous publications have studied seizure ...freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children.
OBJECTIVE
To estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients.
METHODS
A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least 12 months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the preoperative and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg's tests were utilized to detect publication bias.
RESULTS
The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P < .001) and better QOL than matched medically treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P < .001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P < .001), but patients not achieving seizure freedom did not achieve statistical significance (P = .79).
CONCLUSION
Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures, through seizure freedom, which was associated with the greatest improvement in life quality.
Background
The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past ...years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH.
Methods
A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle–Ottawa Scale.
Results
Seven retrospective cohort studies comparing LMH (
n
= 300) versus RMH (
n
= 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90–2.23;
p
= 0.13, severe complications (Clavien-Dindo grade ≥ 3) risk difference (RD) 0.01, 95% CI − 0.03 to 0.05;
p
= 0.72, and overall mortality (RD 0.00, 95% CI − 0.02 to 0.03;
p
= 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI − 0.01 to 0.08;
p
= 0.15), margin-positive resection (OR 1.34, 95% CI 0.51–3.52;
p
= 0.55), and transfusion rate (RD − 0.03, 95% CI − 0.16 to 0.11;
p
= 0.67). No significant difference was observed for LMH versus RMH regarding blood loss standardized mean difference (SMD) 0.27, 95% CI − 0.24 to 0.77;
p
= 0.30), operative time (SMD − 0.08, 95% CI − 0.51 to 0.34;
p
= 0.70), and length of stay (SMD 0.13, 95% CI − 0.58 to 0.84;
p
= 0.72).
Conclusion
LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.
Robot-assisted minimally invasive esophagectomy (RAMIE) was introduced as a further development of the conventional minimally invasive esophagectomy, aiming to further improve the high morbidity and ...mortality associated with open esophagectomy. We aimed to compare the outcomes between RAMIE and open esophagectomy, which remains a popular approach for resectable esophageal cancer. Ten studies meeting our inclusion criteria were identified, including five retrospective cohort, four prospective cohort, and one randomized controlled trial. RAMIE was associated with significantly lower rates of overall pulmonary complications (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.26, 0.56), pneumonia (OR: 0.39, 95% CI: 0.26, 0.57), atrial fibrillation (OR: 0.53, 95% CI: 0.29, 0.98), and wound infections (OR: 0.20, 95% CI: 0.07, 0.57) and resulted in less blood loss (weighted mean difference (WMD): −187.08 mL, 95% CI: −283.81, −90.35) and shorter hospital stays (WMD: −9.22 days, 95% CI: −14.39, −4.06) but longer operative times (WMD: 69.45 min, 95% CI: 34.39, 104.42). No other statistically significant difference was observed regarding surgical and short-term oncological outcomes. Similar findings were observed when comparing totally robotic procedures only to OE. RAMIE is a safe and feasible procedure, resulting in decreased cardiopulmonary morbidity, wound infections, blood loss, and shorter hospital stays compared to open esophagectomy.
Liver transplantation (LT) is the only potentially curative option for children with unresectable hepatocellular carcinoma (HCC). We performed a systematic review of the MEDLINE, Scopus, Cochrane ...Library, and Web of Science databases (end-of-search date: 31 July 2020). Our outcomes were overall survival (OS) and disease-free survival (DFS). We evaluated the effect of clinically relevant variables on outcomes using the Kaplan-Meier method and log-rank test. Sixty-seven studies reporting on 245 children undergoing LT for HCC were included. DFS data were available for 150 patients and the 1-, 3-, and 5-year DFS rates were 92.3%, 89.1%, and 84.5%, respectively. Sixty of the two hundred and thirty-eight patients (25.2%) died over a mean follow up of 46.8 ± 47.4 months. OS data were available for 222 patients and the 1-, 3-, and 5-year OS rates were 87.9%, 78.8%, and 74.3%, respectively. Although no difference was observed between children transplanted within vs. beyond Milan criteria (
= 0.15), superior OS was observed in children transplanted within vs. beyond UCSF criteria (
= 0.02). LT can yield favorable outcomes for pediatric HCC beyond Milan but not beyond UCSF criteria. Further research is required to determine appropriate LT selection criteria for pediatric HCC.
The Revised International Staging System (R-ISS) was recently introduced in order to improve risk stratification over that provided by the widely used standard International Staging System. In ...addition to the parameters of the standard system, the R-ISS incorporates the presence of chromosomal abnormalities detected by interphase fluorescence
hybridization t(4;14), t(14;16) and del17p and elevated serum lactate dehydrogenase. The R-ISS was formulated on the basis of a large dataset of selected patients who had participated in clinical trials and has not been validated in an independent cohort of unselected patients. Thus, we evaluated the R-ISS in 475 consecutive, unselected patients, treated in a single center. Our patients were older and more often had severe renal dysfunction than those in the original publication on the R-ISS. As regards distribution by group, 18% had R-ISS-1, 64.5% R-ISS-2 and 18% R-ISS-3. According to R-ISS group, the 5-year survival rate was 77%, 53% and 19% for R-ISS-1, -2 and -3, respectively (
<0.001). The R-ISS could identify three groups with distinct outcomes among patients treated with or without autologous stem cell transplantation, among those treated with either bortezomib-based or immunomodulatory drug-based primary therapy and in patients ≤65, 66-75 or >75 years. However, in patients with severe renal dysfunction the distinction between groups was less clear. In conclusion, our data in consecutive, unselected patients, with differences in the characteristics and treatment approaches compared to the original International Myeloma Working Group cohort, verified that R-ISS is a robust tool for risk stratification of newly diagnosed patients with symptomatic myeloma.
Abstract Objectives To examine patient and clinicopathological features of malignant urachal neoplasms (MUN) in a population-based cohort, to investigate survival outcomes, and to review the current ...evidence that exists in the literature. Material and methods The Surveillance, Epidemiology, and End Results database was used to identify microscopically confirmed MUN cases diagnosed between 1988 and 2012. Kaplan-Meier analysis was used to determine median and 5-year overall survival (OS) as well as cancer-specific survival (CSS) rates. Cox proportional hazards model was employed to identify variables independently associated with cancer-specific mortality. A systematic literature review was conducted in line with the PRISMA statement. Results A total of 420 patients with MUNs were identified. The majority were white (77.6%) and male patients (59%) who presented with low-grade (62.1%), mucinous, noncystic adenocarcinomas (42.9%). From the cohort, 19%, 15.2%, 29.5%, and 30.5% of the patients presented with American Joint Committee on Cancer Stage I to IV disease, respectively. Cancer-directed surgery was performed in 86.5% of the patients. The most common procedure performed was partial cystectomy (52.4%) followed by local tumor excision (20.7%). Median OS was 57 months (95% CI: 41.6–72.4), and median CSS was 105 months (95% CI: 61.5–148.5). Five-year OS and CSS rates were 51% and 57%, respectively. Grade and stage were independently associated with cancer-specific mortality. Mortality rates did not differ between patients who underwent partial cystectomy and radical cystectomy/exenteration ( P = 0.165), even after controlling for tumor stage. A total of 16 studies reporting on 585 patients were systematically reviewed, and relevant outcomes were summarized in the Supplemental material. Conclusions MUNs are usually low-grade, mucinous, noncystic adenocarcinomas diagnosed at advanced stages. Overall, the prognosis is poor, and high-grade and disease stage are independently associated with cancer-specific mortality.
Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable ...mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (
n
= 642) or device closure (
n
= 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9–99.9) compared to the device closure group (97.3%; 95% CI 95.6–98.2), (OR 0.1; 95% CI 0.02–0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0–19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0–9.8), (OR 2.0; 95% CI 1.2–3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7 days) compared to device closure (1.3 ± 1.4 days), (OR 4.8; 95% CI 1.1–20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7–5.5) compared to the surgical approach (0.95%; 95% CI 0.3–2.4), (OR 0.1; 95% CI 0.06–0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.
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