Excellent outcomes after conservative thyroid surgery for low-risk follicular thyroid carcinoma (FTC) have been reported from highly specialised centres. However, it is uncertain whether low-volume ...hospitals can achieve similar treatment results.
At our institution, 49 patients with FTC were treated during the period 1991-2014. Patients with minimally invasive FTC (MIFTC) were usually treated with hemithyroidectomy. The demographic data, pathology, treatment modality and oncological outcomes of these patients were retrospectively evaluated.
The tumours were classified as Stage I in 40.8% of patients, Stage II in 32.7%, Stage III in 20.4% and Stage IV in 6.1%, according to the TNM classification system. Only 4 (8.2%) patients had widely invasive FTC (WIFTC). Vascular invasion or capsular invasion alone occurred in 9 (19.1%) and 19 (40.4%) patients, respectively, while 19 (40.4%) patients had simultaneous vascular and capsular invasions. 34 (69.4%) patients with MIFTC initially underwent hemithyroidectomy, while 15 (30.6%) patients underwent total thyroidectomy. Ten patients who underwent total thyroidectomy received radioactive iodine ablation. The mean follow-up duration was 86.9 ± 56.6 months. There was no disease-specific mortality, although two patients with WIFTC remained alive with disease at the end of the study. The five-, ten- and 15-year overall survival rates were 95%, 91% and 84%, respectively. Five patients from the hemithyroidectomy group died due to other illnesses with no evidence of FTC.
Satisfactory disease control and excellent survival for MIFTC is achievable by hemithyroidectomy in community hospitals. Total thyroidectomy should be reserved for WIFTC or aggressive tumours with nodal or distant metastasis.
Seasonal pattern of tuberculosis in Hong Kong Leung, Chi Chiu; Yew, Wing Wai; Chan, Thomas Yan Keung ...
International journal of epidemiology,
08/2005, Letnik:
34, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Background Summer predominance of tuberculosis (TB) was reported previously in temperate regions. No consistent data were available for lower latitudes. Method The monthly TB notification data in ...Hong Kong from 1991 to 2002 were examined for seasonal fluctuation. A seasonal model was then developed after standardization by period, sex, age, history of TB, form of disease, and bacteriological status. Results The raw monthly counts showed remarkably consistent seasonal fluctuation across different periods, sexes, and age groups. A sine model was fitted for 82 104 notifications (adjusted R2 = 0.373, P < 0.001). A summer peak was observed with seasonal fluctuation of 18.4% (P < 0.001), which was substantially higher than that reported previously for temperate regions. The amplitudes of fluctuation were 35.0, 15.0, 19.0, and 20.2% for those aged ≤14, 15–34, 35–64, and ≥65 years, respectively (all P < 0.001). No gender difference was noted (18.2% vs 19.0%, P = 0.790). Seasonal pattern was detected among new cases (18.6%, P < 0.001), but not retreatment cases (5.2%, P = 0.333). Culture-positive cases showed greater fluctuation than culture-negative cases (29.4% vs 6.4%, P < 0.001). No significant difference was found between pulmonary and extrapulmonary cases (16.8% vs 21.6%, P = 0.356). TB cases notified in summer were more likely to be smear-positive odds ratio (OR) 1.100, 95% confidence interval (CI) 1.045–1.158, P < 0.001 and culture-positive (OR 1.175, 95% CI 1.121–1.232, P < 0.001) than those notified in winter, even after stratification by other key variables. Conclusion A consistent seasonal pattern was found, with variable amplitudes of fluctuation in different subgroups and differing disease characteristics in different seasons. These observations are suggestive of the presence of a seasonal disease-modifying factor.
Lower lung cancer mortality in obesity LEUNG, Chi C; LAM, Tai H; YEW, Wing W ...
International journal of epidemiology,
02/2011, Letnik:
40, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Malignancy is the leading cause of death in Hong Kong, and lung cancer tops the list of all cancer deaths.
A cohort of clients aged ≥65 years, enrolled at 18 elderly health centres in Hong Kong from ...2000 to 2003, was followed up prospectively through linkage with the territory-wide death registry for causes of death until 31 December 2008, using the identity card number as unique identifier. All subjects with suspected cancer, significant weight loss of >5% within past 6 months or obstructive lung disease at the baseline were excluded.
After a total of 423 061 person-years of follow-up, 932, 690 and 1433 deaths were caused by lung cancer, other tobacco-related malignancies and non-tobacco-related malignancies, respectively. Body mass index (BMI) was independently (and negatively) associated with death from lung cancer after adjustment for other baseline variables, whereas there was only a minor or no effect for other smoking-related malignancies and non-tobacco-related malignancies. Obesity with BMI ≥30 adjusted hazard ratio (HR), 0.55, 95% confidence interval (CI) 0.38-0.80 was associated with reduced lung cancer mortality, which was more prominent than the opposing effect of underweight (adjusted HR, 1.38, 95% CI 1.05-1.79). Consistent effects of BMI were observed after stratification into never-smokers and ever-smokers and in sensitivity analysis after excluding deaths within the first 3 years.
Obesity was associated with lower lung cancer mortality in this prospective cohort analysis. As the effect was rather specific for lung cancer, further studies are indicated to explore the underlying mechanism.
Molecularly targeted cancer therapy has improved outcomes for patients with cancer with targetable oncoproteins, such as mutant EGFR in lung cancer. Yet, the long-term survival of these patients ...remains limited, because treatment responses are typically incomplete. One potential explanation for the lack of complete and durable responses is that oncogene-driven cancers with activating mutations of EGFR often harbor additional co-occurring genetic alterations. This hypothesis remains untested for most genetic alterations that co-occur with mutant EGFR. Here, we report the functional impact of inactivating genetic alterations of the mRNA splicing factor RNA-binding motif 10 (RBM10) that co-occur with mutant EGFR. RBM10 deficiency decreased EGFR inhibitor efficacy in patient-derived EGFR-mutant tumor models. RBM10 modulated mRNA alternative splicing of the mitochondrial apoptotic regulator Bcl-x to regulate tumor cell apoptosis during treatment. Genetic inactivation of RBM10 diminished EGFR inhibitor-mediated apoptosis by decreasing the ratio of (proapoptotic) Bcl-xS to (antiapoptotic) Bcl-xL isoforms of Bcl-x. RBM10 deficiency was a biomarker of poor response to EGFR inhibitor treatment in clinical samples. Coinhibition of Bcl-xL and mutant EGFR overcame the resistance induced by RBM10 deficiency. This study sheds light on the role of co-occurring genetic alterations and on the effect of splicing factor deficiency on the modulation of sensitivity to targeted kinase inhibitor cancer therapy.
A cohort of 42,655 clients that were first registered with the Elderly Health Service in 2000 were followed prospectively through the tuberculosis (TB) notification registry until the end of 2002. A ...total of 286 active TB cases (186 culture confirmed) were identified. The annual TB notification rates were 735, 427, and 174 per 100,000 among current smokers, ex-smokers, and never-smokers, respectively (p < 0.001). The trend in TB risk persisted after the control of background characteristics using Cox proportional hazards analysis (adjusted hazard ratios HRs: 2.63, 1.41, and 1, p < 0.001). In comparison with never-smokers, current smokers had an excess risk of pulmonary TB (adjusted HR, 2.87; 95% confidence interval CI, 2.00-4.11; p < 0.001), but not extrapulmonary TB (adjusted HR, 1.04; 95% CI, 0.33-3.30; p = 0.95). Among the current smokers, those who developed TB smoked more cigarettes per day than those who did not (13.43, SD 8.76 vs. 10.96, SD 7.87, p = 0.01). A statistically significant dose-response relationship was observed with respect to active TB and culture-confirmed TB (both p < 0.05). Smoking accounted for 32.8% (95% CI, 14.9-48.0%), 8.6% (95% CI, 3.3-15.1%), and 18.7% (95% CI, 7.7-30.4%) of the TB risk among males, females, and the entire cohort, respectively. Approximately 44.9% (95% CI, 20.7-64.6%) of the sex difference was attributable to smoking.
HDL is anti-atherogenic and has antioxidant property. HDL dysfunction has been reported in patients with coronary heart disease and we hypothesize that HDL may also be dysfunctional in obstructive ...sleep apnea (OSA), a condition associated with increased oxidative stress.
128 OSA patients and 82 controls were recruited. HDL dysfunction was determined by evaluating the ability of HDL to inhibit LDL oxidation ex vivo. Plasma HDL was incubated with native LDL in the presence of dichlorofluorescein which fluoresced upon interaction with lipid oxidation products. Plasma levels of oxidized LDL and 8-isoprostane were measured by ELISA and a specific enzyme immunoassay, respectively.
Plasma total 8-isoprostane levels were elevated in OSA subjects (
p
<
0.01). Despite having similar concentrations of plasma lipids and apolipoproteins as controls, OSA subjects had greater degree of HDL dysfunction (
p
<
0.01) and increased oxidized LDL levels (
p
<
0.05). The apnea–hypopnea index was the main determinant of HDL dysfunction in OSA, accounting for 30% of its variance, with oxidized LDL and apolipoprotein AI contributing to 8% and 5% of its variance respectively (
p
<
0.001).
HDL is dysfunctional in preventing the formation and inactivation of oxidized lipids in OSA subjects and may partly contribute to their increased cardiovascular risk.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To evaluate the acute‐phase efficacy and safety of parenteral direct thrombin inhibitors and factor Xa ...inhibitors in people with ACS during hospitalisation, with rank ordering by using network meta‐analysis.
Influenza virus infections are causing substantial morbidity and mortality, despite availability of antiviral treatments. Macrolides have been shown to ameliorate inflammation in respiratory diseases ...and provide clinical benefits. Data in influenza, however, are scarce. We aimed to assess the anti-inflammatory effects of macrolide treatment in patients with influenza, and its effects on viral clearance and symptom resolution.
In this open-label, multicentre, randomised controlled trial, we recruited adults admitted to hospital for laboratory-confirmed influenza in Hong Kong. Key inclusion criteria were age 18 years or older, influenza A and B virus infections confirmed by PCR or immunofluorescence assays, and presentation within 4 days from illness onset. Patients were randomly assigned (1:1) using a computer-generated sequence to oseltamivir (75 mg twice daily) plus azithromycin (500 mg per day) or oseltamivir (75mg twice daily) alone, both given orally for 5 days. The primary outcome was change in plasma cytokine and chemokine concentration over time (day 0–10), analysed by intention to treat. Generalised estimating equation (GEE) models were used to analyse longitudinal data, and were adjusted for potential confounders. Ethics approvals were obtained from the institutional review bodies of all participating institutes. All patients provided written informed consent. This trial is registered with ClinicalTrials.gov, number NCT01779570.
During the influenza seasons beginning from 2013–14 through to 2015–16, 50 patients were randomly assigned to the oseltamivir-azithromycin (n=25) or oseltamivir (n=25) groups, with similar baseline characteristics (mean age 54·7 years SD 18·5 in the oseltamivir-azithromycin group vs 58·6 years 18·1 in the oseltamivir group; 16 64% of 25 patients in the oseltamivir-azithromycin group were men vs 15 60% of 25 in the oseltamivir group). Three key pro-inflammatory cytokines declined faster in the oseltamivir-azithromycin group than in the oseltamivir group: interleukin (IL)-6 (GEE β=–0·037 95% CI −0·067 to −0·007, p=0·016; change from baseline −83·4% vs −59·5%), IL-17 (β=–0·064 –0·117 to −0·012, p=0·015; −74·0% vs −34·3%), and CXCL9 (β=–0·010 –0·020 to 0·000, p=0·043; −71·3% vs −56·0%). Non-significant differences in the following cytokines were observed between treatment groups: CXCL8 (β=–0·018 –0·037 to 0·000, p=0·056; −80·5% vs −58·0%), sTNFR-1 (β=–0·003 –0·006 to 0·000, p=0·084; −40·1% vs −24·8%), IL-18 (β=–0·006 –0·015 to 0·003, p=0·197; −29·1% vs 30·2%), and C-reactive protein (β=–0·033 –0·088 to 0·022, p>0·10; −77·5% vs −48·2%). Two serious adverse events (SAEs) occurred in the oseltamivir-azithromycin group (Pseudomonas aeruginosa pneumonia, post-influenza vestibular neuronitis onset after stopping treatment for 1 week) versus one SAE in the oseltamivir group (increased ascites; p>0·99); all SAEs were considered unrelated to treatment. Other common adverse events were gastrointestinal or hepatic symptoms (five 20% of 25 in the oseltamivir-azithromycin group vs four 16% of 25 in the oseltamivir group; p>0.99) and dizziness or hearing symptoms (two 8% vs two 8%; p>0·99). All events were transient and reversible, and no participants died in this study.
We found significant anti-inflammatory effects with adjunctive macrolide treatment in adults with severe influenza infection. The clinical benefits of a macrolide-containing regimen deserve further study.
Research Grant Council of the Government of the Hong Kong Special Administrative Region, China (468112).
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